Too much dialysis?

I’m writing for my husband, anthonyB. He has been on PD, night time cycler for over 1 year. He used 1.5 yellow, 8000 ml, and was dry during the day. Things were fine until June. A Pet test showed he could actually use less dialysis, so they reduced him to 6000ml. We went on a fishing trip to Canada, and he was sick by the end of the week. Loss of appetite, nausea, food tasted strange. So he went back on 8000 ml, but further tests showed fluid around his heart. He had surgury, was hospitalized twice more for gastric issues and uncontrollable diarrhea. Long story short, after a colonoscopy, endoscopy, esophogram, biopsies, stool cultures, etc. nothing definitive was found. A gastro doctor thought he may have gotten a bug in Canada that turned his good bacteria count upside down and prescribed an anti biotic. He felt the peritoneal dialysis was compromised by this intestinal issue. However his kidney doctor and nurse feel the symtoms mimic kidney failure, so they have increased his dialysis to 10,000 ml and added extraneal for a day time dwell. A second Pet test and creatine test showed some improvement, but not back to the June levels. While his eating and taste issues have improved, it seems he can’t gain any weight back and his skin just hangs on him. We think he’s getting too much dialysis, but the kidney folks are adament. Anybody with any similar story out there? Is it possible to get too much dialysis?

No, it is NOT possible to get too much dialysis. There is no such thing. Healthy kidneys work 24/7, and provide a glomerular filtration rate (GFR, or level of kidney filtering) that is normally about 90% or greater. By way of comparison, even good PD might get you about 15%.

It IS possible to remove too much water, though. Dialysis removes wastes, and it removes water (ultrafiltration). Getting too dry (being dehydrated) makes you feel pretty wretched.

You said that after Anthony’s PD dose was reduced (why they would do this when he was doing well, I can’t imagine), he felt “Loss of appetite, nausea, food tasted strange. So he went back on 8000 ml, but further tests showed fluid around his heart.” All of those symptoms–including the fluid around his heart–are signs of underdialysis. Or, they could be caused by something else. We’re not doctors, but the “food tasted strange,” in particular REALLY makes it sound like uremia. Did you by any chance notice that he had ammonia breath when this was happening?

My guess is that reducing his PD dose that first time destabilized his whole system. He became uremic, and it’s been an uphill climb to try to get back to where he started out. Getting more protein into him may help. Talk with his dietitian about his blood protein (serum albumin) level, which should be 4.0 g/dL or more, if possible. There are tasteless protein powders that can be added to foods.

It may also be that he needs more waste clearance than he can get with PD, and switching to a form of home hemo that is every day or every night might help him feel much better. He is most definitely NOT getting “too much” dialysis, though.

I believe a person can get too much dialysis. The kidneys don’t have to do anything if a person gets dialysis all the time. My husband went on dialysis at a dialysis center in December. His kidneys failed when he was hospitalized with pneumonia. They were probably not too healthy to start with because he is a diabetic. After several weeks of 3 times a week, 4 hours each time, he was feeling so wretched and drained he was about to just quit going. I called his doctor and she thought maybe she was drying him out too much and cut back the dialysis time by 15 minues each day. After this, he starting urinating some. He felt a little better too. Then he missed a day of dialysis due to some unrelated illness and he urinated a lot more. I believe his kidneys were just dried out and not required to work at all. When the “pump got primed” a bit, they starting working. We had to insist on his being tested to see if his kidney function had improved enough to get off dialysis but, finally, the test was done. His kidney function improved with less dialysis and now he is completely off dialysis. I’m not saying this work work for everyone but I do think the dialysis can be overdone, drying those kidneys out so much, there’s no hope of any function ever returning.

This message board is for people on PD. If your husband was on dialysis 3x/week for 4 hours, he was doing hemodialysis, not peritoneal dialysis.

What you describe as “too much dialysis” sounds more like too much fluid removal. Also, it sounds like your husband’s diabetes may have caused some kidney damage and the bout of pneumonia caused temporary (acute) kidney failure. People with acute kidney failure may recover kidney function after damaged kidneys have a chance to rest with dialysis. It sounds like this is what happened with your husband. However, if someone has chronic kidney failure, the kidneys are so badly damaged that kidney function won’t get better and the person will need ongoing dialysis or a transplant to survive.

Hopefully your husband is being followed by a kidney doctor who can test his blood and advise him regularly how his kidneys are functioning and prescribe medications and a diet to protect whatever kidney function he has.

I was having agonizing cramps almost every night while on 12500/ml 1.5% solution at night and 2500ml daytime. I have alot of RKF. My clinic eliminated my daytime exchange and the cramping improved a bit, but I still have cramps. My clinic is reluctant to lessen my PD regime but when I experiment on my own…less PD equals less cramping. The cramping happens most often at night preventing me from getting sleep, not to mention the PAIN. I know its a complicated issue balancing my blood electrolytes etc. but the cramps are making me want to … Any thoughts?

Hi Guest,
You might try also posting this question to our expert PD nurse, Judith Bernardini in our Ask Our Experts forum. She may have some thoughts for you. You can see that forum here:

I think by doing regular dialysis you can know of the regular diseases growing in his body .Experienced doctors can be aware of his condition and prescribe best for him so no matter how long been the dialysis but you are aware of his true situation .Be positive I think yo have lost your spirit of fighting .Good luck