Hi everyone 
I’m currently doing shared care at the unit whilst waiting for my machine install.
Anyway, i was talking to my shared care nurse and she asked me what i was planning to do when on HHD. I told her that i was planning to do 8 hrs every other day.
She advised me to talk it over with the home care team as you can actually have too much dialysis (her exact words)
Is this actually true? I’ve never heard this said by anyone before. I use Dr Agar’s blogs and videos like my dialysis bible and feel i’ve learned a ton from doing so. I trust that what i’m planning will be good dialysis, at least better than the 2hrs daily that i was recommended by my nurse anyway.
So-yeah, i just wondered. We often hear about in center dialysis being too short, but at what point would longer dialysis treatment be considered too much dialysis?
I’ve heard staff tell patients this. However, when healthy kidneys work 168 hours a week, I don’t know how you can have too much dialysis by doing it every other day for 8 hours unless nurse was concerned you might pull off too much fluid too fast. That can stun your organs. However, patients who do 8 hours of dialysis 3 or more times a week usually do it while sleeping (nocturnal HD). They use a slower blood flow rate than standard dialysis done 3x a week for 3-4 hours. With longer/NHD, patients’ blood pressure, fluid management, and labs are better. Dietitians have told me that nocturnal HD patients can eat a more normal diet because slower dialysis allows better removal of phosphorus that is hard to remove during shorter treatments. Doing NHD may help patients live longer and have higher quality of life.
A 2019 article linked below reported on NHD compared to standard 3x weekly HD:
"NHD (most often done at home) has been associated with a number of benefits including better control of intradialytic weight gain and blood pressure, and improved phosphate control.18 It is known that in prevalent HD patients, volume overload is associated with an increased risk of mortality,21 and thus the improved volume management with NHD may lend itself to a survival advantage. The improved solute clearance observed with NHD may also allow patients to liberalize their diets, thus improving nutrition.22 In addition, a more frequent dialysis schedule (short daily or frequent nocturnal) may mitigate the known mortality risk associated with a 2-day dialysis break with conventional thrice weekly HD (22.1 vs 18.0 deaths per 100 person-years on the day after the long interval vs all other days, P < .001).23
Thanks Beth, yes i suspect it was just a default response from the nurse along the same lines as the ’ the higher the pump speed, the better the clearance’ one we are always hearing at the unit.
Thanks for your response, i appreciate it
I think that’s a common belief. Unfortunately, the higher the pump speed, the more likely it is to cause organ stunning, which can damage the fistula and the heart. You might want to share the Home Dialysis Central website and these blogs with your nurse. The KidneyViews blogs (like these) are written for professionals, but we know patients like you read them.
Excellent blogs Beth, thank you for sharing.
You can over dialysis for certain, and this country is the largest culprit. Promoting five days a week in HHD is excessive ESPECIALLY if a patient has residual urine output. You don’t have to lose your output if you drink enough fluid and don’t dry out your body. How can you urinate if someone restricts your fluids to 32oz and then removes liters from you? What fluids does the body have to filter? end rant
If you do 3 days a week it’s a detriment to the company as they will be at a financial loss in the states. When utilizing a company like Tablo, in order to recoup costs you need a minimum of 4-5 treatments a week. Typically the 5th day is the only way they are profitable.
With this being said, our patients have BUN 60-100, they have Creatinine of 7-12 and they are out golfing and enjoying the highest quality of life. What does this mean? It means you don’t need to have a bun of 21 or a creatinine of 3. We have 125 patients that utilize our less invasive treatments and they couldn’t be happier.
Long and short: yes you can overdialyze, but I don’t think that’s the real reason they said this
I think you can take off too much fluid during dialysis, which makes a patient feel awful. Standard HD done 3x weekly only replaces about 15% of kidney function so far as removal of wastes. It’s far better to do more HD treatments a week or do longer HD treatments. Some patients do every other day HD. Others do HD overnight while they sleep. From what I’ve read, nocturnal HD done for 6-8 hours per treatment provides the best waste removal with the shortest recovery time after the patient gets off dialysis.
I understand that dialysis clinics want to maximize their revenue, but it’s as important to maximize patient’s health so they are hospitalized less and live longer. When a doctor prescribes >3 HD treatments a week and the patieint has a commercial plan, that plan is likely to pay for every treatment the clinic provides. But when a patient has Medicare as his/her primary payer, the patient’s nephrologist must submit medical justification to support why >3 HD treatments are needed weekly because Medicare reimbursement rules limit routine payment to 3 HD treatments a week. PD is a daily treatment and Medicare pays for all 7 days but Medicare reimburses at a rate that is equivalent to payment for 3 days of HD treatments a week.