I’ve never seen any statistics about that. It’s hard to even find out the exact number of people who are on these home hemo treatments.
At the home dialysis unit I’m “attached” to, you train initially for short daily, and then you can either stay on it or you can spend 3 nights at the hospital to “convert” to nocturnal. A few decide that they like the short daily, but the overwhelming majority choose nocturnal, for good reason.
As you know, I was on short daily for 4 whole months (not just a few days), and now I’ve been on nocturnal for more than 6 months. Short was Ok and I would happily do it if I had to, but the benefits of nocturnal are so overwhelming in terms of diet/fluid and lab results that there’s just no comparison and no going back. I don’t know if it’s the same for everyone, but even a doctor who looks at my post-tx labs would not be able to tell I even have kidney failure if he didn’t know. I’m not kidding - it’s that good. There is nothing abnormal in it whatsoever. Even my creatinine is better than what most transplant recipients get. It’s perfectly normal. Moreover, I can’t know for sure, but it’s got to be better for the heart to remove fluid at the rate of 300ml/hr than it is at the much higher rates you need when doing short treatments. For me, it sure feels better.
I always found it unbearable to wait for a treatment to finish at the centre, and I kind of felt the same way even to sit for a 2 hour short daily at home during the day. With nocturnal, it doesn’t feel that long at all, even though it’s 7-8 hours. This is because once I get on at about 10:30 or 11, I fall asleep shortly after and I rarely wake up again until near the end. So it doesn’t seem as long. Yes, the first few weeks were harder in terms of sleeping all night, but I got used to it pretty quickly.
I said at the start of this message that I would happily go back to short daily if I had to. Now, when I say that, I mean 2 hours 6 days per week. There is no way in the world that I would willingly do more than 2 hours like some of the members here do. More than that and it starts feeling much like an in-centre treatment in terms of length. It would just be too long to do that day in and day out indefinitely - for me anyway. Given 2 hour short and 7 hour nocturnals, with short running at 500/400 and nocturnal running at 300/300 (dialysate pump /blood pump), this means that every single treatment runs this much blood through the dialyzer:
- short daily: about 40-45 litres
- nocturnal: about 120 litres
Now multiply that by 6 for the week. That’s 270 for short daily, 720 for nocturnal (7 hours tx). You can see that nocturnal is miles ahead of short daily, even though the blood pump is slower. I mean, they aren’t even in the same league.
So, this is why I prefer nocturnal. I get so used to no diet of any kind that I don’t even like to take an extra night off even though I could.
However, I wouldn’t mislead anyone. I do it because of the dietary and expected health advantages, but it does come at the sacrifice of more limited movement during sleep, and it’s a lot of trouble doing it every night. If I wake up at night and hear something, I can’t even get up to go look out the window. I miss that. In my opinion, it also requires much more attention to everything being done just so - because other than the machine alarms and the leak alarms, nobody is watching over you all night. However, the advantages greatly outweigh any disadvantages as far as I’m concerned. I’m not wedded to nocturnal, as I could switch back to short daily any time I want to. But I wouldn’t want to. Nocturnal is so good that I’m not even as enthusiastic anymore about the possibility of getting a kidney transplant. I still want it, but I know I probably won’t do as well in some respects.
To me, the type of machine is very secondary to just the opportunity of doing nocturnal. On my Fresenius, I test the water, then I turn it on (I often do this test earlier in the day). After that, it’s a simple matter of connecting only 3 tube parts: the arterial segment connects to the dialyzer and to the drain bag at the other end. The veinous connects to the dialyzer and to the drain bag also, and the saline administration line connects from the saline bag to a little connection on the arterial line. That’s all there is to it (there are some openings and closings of clamps, but it’s easy). Once that’s done, the machine does its alarm test (about 7 minutes). At the same time, I prepare my needle and gauze tray and the strips of tape. Then I do a quick manual test of the conductivity, after which I let the saline recirculate for 10 minutes (and it can be longer if I want to do something else - I just let it go on longer). While that’s happening, I weigh myself, take my temperature, measure my blood pressure and do my quick calculation of UF goal for that night. Then I put the needles in and I’m on. No matter how simple the machine, you are still going to spend the same amount of time preparing the needle “tray”, and the same amount of time putting the needles in and doing all the taping, etc. All of that together takes me about an hour, without working especially fast, and during that time, I have time to check my email, etc. I don’t have to be standing at the machine while it recirculates or while it does the alarm test.
In the morning, a couple of minutes to rinse my blood back using the machine’s pump, just a minute or so to remove each needle and 10 minutes to hold each site. After that, it takes all of about 1 minute to pull everything off the machine and throw it away. Then I set the machine to acid clean and go back to bed while it’s happening (about 15 minutes). Once that’s done (the machine tells me) I quickly set it to heat disinfect and I again go back under the blankets until it’s over (about 45 minutes). That’s it. The machine turns itself off (it doesn’t run all day like the PHD would), and I manually switch the R/O off. Then I’m free for the entire day, every day, until about 10pm.
If I consider the concurrent activity which goes on during the preparation including things that even people using NxStage have to do, my pre-tx prep is more like half an hour than an hour. On the occasional day I have to go in centre like say because my doctor ordered a Transonic, I like the fact that the machines there are identical to mine. Even the ones in the acute dialysis units in the two general hospitals are the same. I like that because I can easily operate it myself to the extent that they let me, and I know everything that is going on. I like that.
There are two ways to improve hemodialysis: frequency and length of treatment. With short daily, you get one - frequency. With daily nocturnal, you get both frequency and you get length of treatment in a big way.