The need for keeping the ultra-filtration goal within prescribed limits of volume and speed has been thoroughly documented. Many dialysers confirm the unpleasant sensations/symptoms following organ stunning as a consequence of too rapid fluid extraction.
Less well documented is the assault on ones system of having all ones blood leave its rightful home to be circulated through a foreign object around 16 times in 4 hours. Whilst red cells may not possess nuclei they are nonetheless living cells with a lifespan of around 100 days in healthy individuals. Spare a thought for them: soft-membraned and flexible they are sucked from the dark interior of the satin-smooth endothelium-lined fistula to be squeezed under pressure in bright light through thousands of synthetic fibres only to be pitched back again to await another round. …
Anthropomorphic drivel? Maybe, but I had a read of the fine print on the pamphlet supplied by Fresenius with my new carton of capillary high-flux dialysers. Adverse effects may occur during dialysis and may result from factors specific to the patient. Indeed, many confirm the philosophy that a “one size fits all” is a limited way to approach a patient initiating dialysis.
The pamphlet goes on to describe symptoms to look out for: dyspnoea, chest congestion, bronchospasm, respiratory arrest, hypotension, tachycardia, nausea, flushing, bradycardia, urticaria, angiodema, ouch!!! - to name a few. I think most of us can confirm hypotension and nausea. The cautionary note continues: hypersensitivity or hypersensitivity-like reactions have been observed mainly in the first weeks of treatment with the dialyser …treatment intensity should be gradually increased to permit adequate adaptation.
While graded increase of treatment intensity is not a call to incremental dialysis it does make a plea to allow adaptation and adjustment to a highly invasive procedure.
I suspect many patients accept initial difficulty, strain and pain as par for the course; it need not be so. To pitch straight into full treatment within the first week or two is an assault on ones physiology (with one’s psychology already under strain) and would surely only be necessary in the case of acute or total kidney failure.