Florida Dialyisers

I just came back from a wedding in NJ and was talking to a cousin from Florida who works for BC/BS. She will be attending a Center Administrators meeting in Florida this week.
We had quite a conversation. She was telling me that Fresenious is in the process of setting up in-center nocturnal dialysis centers all over Florida. Fresenious is finding out that people with more dialysis are doing so much better. Hallalua!!! I told her that she could certainly give them our names, phone number and e-mail so I can have them contact our center in Clifton Park NY. I hope that someone does indeed call/e-mail so I can get on my band wagon and let them know how wonderful it is.

Just thought you all might like to know.
Pat Colongione

This is cool news, do you know how many patients will they accomodate per center?

Hi Gus,
No I don’t but as soon as the cousin lets me know anything I will pass it on.

Okay great, no rush…kinda wonder why only in Florida…perhaps its where fresenius resides?

Fresenius is an international company with headquarters in Germany. Its US headquarters are in MA. Looking at the Kidney Options (www.kidneyoptions.com/hemo.html) website, it discusses briefly nocturnal in-center dialysis. Therefore, I suspect Fresenius is doing this in other parts of the country. I heard a few months ago that there were plans for a clinic in the Kansas City area to start offering nocturnal in-center hemo.

I know it would be great for people without willing partners to get the benefits of longer dialysis, but I still believe that there are so many benefits of doing home dialysis, that the best case scenario is if patients do nocturnal dialysis at home. This way they will have a consistent cannulator, be in the comfort of their own home, sleeping in their own bed, and not having to drive to a clinic and be separated from family 3 nights a week (the number of treatments FMC clinics provide when nocturnal is done in center).

Hi y’all,

Beth said:

I know it would be great for people without willing partners to get the benefits of longer dialysis, but I still believe that there are so many benefits of doing home dialysis, that the best case scenario is if patients do nocturnal dialysis at home. This way they will have a consistent cannulator, be in the comfort of their own home, sleeping in their own bed, and not having to drive to a clinic and be separated from family 3 nights a week (the number of treatments FMC clinics provide when nocturnal is done in center).

I agree that home is best–whenever it’s possible–for just the reasons Beth said. But for folks for whom it isn’t possible, nocturnal in-center is an excellent alternative to in-center short hemo:
– Patients get twice as much (or more) dialysis
– The diet and fluids are less limiting
– Treatments are slower and more gentle; easier on the heart and less downtime afterward
– Blood pressure meds can often be reduced
– Dialysis doesn’t take time out of the day, making employment more possible

In-center nocturnal also offers a great alternative for people who do home nocturnal and want to travel without having to switch to conventional dialysis.

So, here’s my question to all of you:
We’ve limited our database to treatments done at HOME only. Should we include in-center nocturnal programs if providers are willing to share that info with us?

There are so many different uses of the same terms for different things that it can get a little confusing. I don’t see how it could possibly be cost-effective to offer daily nocturnal hemodialysis in-centre. Are they talking about quotidian nocturnal hemo (daily), or just 3 nights per week? If it’s the latter, it’s only “nocturnal” because it’s done overnight. It’s not nocturnal in the sense of daily nocturnal hemo.

After being on daily nocturnal for a while now, I would never want to do anything else. It’s almost like not having kidney failure at all. In fact, I would say I feel and look better and healthier than many kidney transplant recipients I know.


Hi Dori,
I think you should included the in-center nocturnal as well and perhaps they will keep you posted on which sites would accept the travelers as well. That would be very helpful. At least when we travel we could be assured of more dialysis than normal 3 times a week dialysis.

According to the Kidney Options (a Fresenius patient education) website, people who do nocturnal home hemo do dialysis 4 nights a week. People who do nocturnal in-center dialysis do dialysis 3 nights a week. Medicare pays for all these treatments so clinics don’t have to lose money on the extra treatments some clinics provide when they offer dialysis 5-7 nights a week.

I suspect that the more nights you do nocturnal, the more it is like normal kidney function. I haven’t seen data about how 3 nights a week dialysis compares to 4-5 or more nights so far as diet and fluid restrictions, lab values, quality of life.

I agree with Dori that there could be a benefit for patients doing nocturnal at home and wanting to travel, being able to do 3 long treatments a week to have your days free on vacation, especially if patients do have less restrictions, similar lab improvements to 4-5 nights a week, and better quality of life.

So basicly you can do Nocturnal every 2 days while you sleep? Like say 6-8 hours? Or is that dependent on body weight?

Daily nocturnal hemodialysis as pioneered in Toronto during the 1990’s is 6 nights per week, 6 to 8 hours. This has the twin advantages of both longer and more frequent treatment. This absolutely maximizes the health benefits. When you do it this way, you can kiss diet and fluid restriction goodbye, and this is no exaggeration.

From what I can tell in my program (and I am on daily nocturnal now, 6 nights), the choice of treatment time from 6 to 8 hours has little to do with patient weight or anything like that (although I guess it might in some cases). It’s more a personal choice. Say you choose 6 hours. That means you either have to start very late (when you might be already too sleepy to setup the treatment), or you have to get up very early. With a 6 hour treatment, if you’re on treatment at 11, that means the treatment ends at 6am, not including post-treatment time. A person wanting to go to bed at 10 would have to get up at 5am. So, a person might prefer to be on treatment for 7 or 8 hours in order to not have to get up so early, or to start treatment earlier.

I’m not sure what advantages there would be to doing nocturnal treatments only 3 or 4 times per week, other than freeing up daytime. If you do it less than 6 times, or at the very least, 5 times per week, then you have to watch the fluid and what you eat more on those off days. Would it be worth the trouble of doing nocturnal 4 nights per week? Hard to say. To me, it doesn’t seem that different than people who are already doing in-centre 3 times per week for 5 hours. I know quite a few who have to do this, because 4 hours isn’t long enough for their needs. I don’t think there is much data or empirical experience with that. Having been on 3/week in-centre (3-1/2 hours a treatment for me) for 3 years, I’m not sure it would be worth having to sleep at a dialysis centre 4 nights per week. Now, if you’re doing it at home, it’s a different story, but then, if you ARE doing it at home, a person may as well do 5 or 6 nights per week and get the full advantage, otherwise, what’s the point, really. No matter what machine a person uses, it’s a lot of effort to manage ones’ own hemodialysis at home. There’s the treatment itself, the needles, etc., but there’s also managing and storing the supplies, and there’s no guarantee that everything always goes well. It can be a little stressful at times. I wouldn’t want to bother if it didn’t give me the dietary and fluid advantages I’ve talked about. It just wouldn’t be worth the trouble.

I can understand how people who haven’t had the experience with daily nocturnal hemo might be skeptical, but, as I said before, except for having to actually do the dialysis, it’s like not having kidney failure at all. The fewer treatments you have per week, the farther away you get from that.

At my home hemo unit, they expect to start in-centre short daily in the near future. I could see that as a reasonable alternative for people who can’t do it themselves at home for whatever reason, but I’m not sure I would want to have to sleep 4 nights per week at a dialysis centre.


Now that I did dailyHemo perhaps I might wanna try the Nocturnal and compare the results…

Btw, I assume you still have your kidneys and can still PEE a bit…correct? :roll:

I do have my kidneys, but after 3 years on dialysis, they are probably little shrunken rumps by now. I don’t pee that much, maybe a cup per day when I’m on the daily run of treatments. Whether you do or not doesn’t make that much difference when doing daily nocturnal anyway, because it’s so frequent and long. Whenever I see my dietician, it’s nice to only be told each time to make sure I eat a lot :slight_smile:

They don’t even give you a protein goal, because since diet is unlimited, you’re unlikely to not be eating enough.


Interesting, hmm…I myself had my kidneys removed…however, my Albumin is low…I’ve been eating like mad but no major improvments on albumin. I am also on protein suplements…geez, and it’s still a bit low… :roll:

Now I kinda wonder what will happen if I do Nocturnal, prolly my albumin will go even lower… :oops:

Low albumin can be due to poor absorption or acute or chronic inflammation as well as not eating enough protein. Have these other causes been ruled out? Here are the NKF nutrition guidelines from 2000. I’m not sure if they’re being updated or not, but you might want to see if you get any ideas of things to ask your doctor or nurse.

You might also want to read the Kidney School nutrition module to see if it gives you any ideas (www.kidneyschool.org).

It could be because of my thyroid removed several years ago…dunno yet…

Keep in mind that it’s much easier to maintain adequate nutrition when you don’t have to worry at all about phosphorus, and not too much about potassium, simply because there are so many more appetizing things you can eat.

My diet has been quite liberal, pizza, all that wonderful cheese, sour cream, you name it. I use to take Renegel before ever starting home dialysis and today Renegel is a thing of the past.

But sometimes I wonder, perhaps we’re getting too much dialysis that some minerals or nutrients may drop too low leaving us lopsided in some areas of our lab chemistry.

Hi Gus

When I was waiting my turn to start training for home hemo, I also had some worries that either form of daily would end up being too much dialysis. But, I’m pretty comfortable with the experience of Dr. Pierratos’ team in Toronto. They’ve been doing daily nocturnal for over a decade )(they pioneered the concept), and they don’t seem to have noticed any deficiencies. The program I’m in is modeled after the Toronto one.

Didn’t you say somewhere you were doing something like 3 or more hours per day? Maybe that’s why the standard duration of treatment for short daily is 2 hours. Maybe more is too much when done 6 days a week. I think nocturnal is different because of the slower pump speeds used. At night, I sleep through most of it, but after doing short daily for a few months, I don’t think I could stand to do longer than 2 hours during the daytime every day. That would be too much for me.


Okay I see now, that’s more clear now. Basicly all the settings are very low while doing Nocturnal…I’d never know until I try it…

Am doing 2.5 hours daily…first I use to be on for 2 but switched to 2.5

My labs and the way I feel are quite well as far as the albumin a bit on the low side.

One of the hardest part is getting the habit back of eating salty foods…something I avoided for many many years…

Before I started daily hemo I had a blood pressure of 190/90…

After only 3 months doing daily hemo my pressure is down to as low as 80/56

Now I gotta stack my cabinets with beef jerky, Cambell’s Soup, I mean the saltiest foods I can find… :roll: