I had occasion to be on short daily March, April, May and half of June this past year, and daily nocturnal from June until now, but, with some short dailies more recently. Here are some urea numbers some of you may find interesting:
BTW, numbers are mmol/L SI units used in Canada (normal range is about 2.5-8.0 for adults)
Short daily:
May 2005 Pre: 12.9 Post: 5.6
Nocturnal:
August 2005 : Pre 7.4 Post 1.1
October 2005 : Pre 6.6 Post 1.0
November 2005 : Pre 7.7 Post 0.9
December 2005 : Pre 5.2 Post 1.0
Short daily:
January 2006: Pre 10.2 Post 3.9
(this short daily was preceded by a nocturnal 2 nights before, so results may be a little better than with a long string of short dailies)
Short daily is pretty good, but it’s clear that nocturnal is exceptionally good. My short daily post ureas are comparable in range to nocturnal pre ureas, and nocturnal post ureas are normal (actually below normal post). Urea Reduction Rate on short is 62%. Not calculated for nocturnal since there’s not much point to calculating URR when urea is normal.
The short dailies are all 2 hour treatments, the nocturnals 7 hour treatments at slower speed. Same machine, same dialyzer, etc. Prescriptions identical except for blood and dialysate pump speeds. A short daily processes about 40 litres of blood through the dialyzer per treatment, and nocturnal about 120 litres per treatment.
P.S. An 8 hour nocturnal tx processes about 135 litres of blood per tx.
I typically process 75 liters of blood a treatment and in the states BUN normals are 10-20. My pre’s are 25 and posts 8, so very similar to yours. However, I never tended to have high BUN’s. Pre dialysis they were only in the 60’s, while my creatinine was in the 7s.
Keep in mind I’m not comparing me against someone else. I’m comparing my own lab results to my own lab results - so what I get is what I get. We know that each individual can be different, but I have to say, these results are very typical in my home dialysis unit according to my nephrologist. I’m not saying short daily isn’t adequate as well. It sure is, compared to 3/week hemo.
Cathy, you process more blood simply because your treatments are longer than the standard 2 hours short dailies I use.
Yes, my own results only. But, I’m a constant in that equation, so it’s really directly comparing standard 2 hour short daily vs daily nocturnal.
Pierre
5’3, 62 kg, my own kidneys (but the damned things don’t work worth heck)
P.S. Other numbers are pretty outstanding. For example, I had a hemoglobin of 110-112 consistently on conventional hemo. Since being on daily, it’s more like 125-130. My last results were 131, the highest hemoglobin I’ve ever had since well before I even started dialysis!
I am a big believer in nocturnal, but also know that everyone reacts differently to dialysis.
I have to dump blood because my HGB and HCT are above normal (obviously I don’t take epogen), why?? I have no idea, I did need nominal epo when I first started but now, even with dumping a full line and dialyzer of blood a month and only using 250cc of saline to return blood (meaning the lines are not clear) my counts are still above normal.
Daily works for me, I do not believe 2 hours a day would work for me, and wonder about others as they say the potassium and phosphorus are removed later. Mine are normal, but not low.
As I understand it, you get all the potassium removal you need very early on in a hemo treatment. Potassium is not a problem at all in 2 hour treatments, and in fact, I can comfirm this from the same labs from which I got the ureas I posted. Short daily (2 hrs) potassium numbers are pretty much the same as long nocturnal ones. It’s more a function of your potassium bath than length of tx. Phosphorus on the other hand, benefits from longer treatment. Daily 2 hours is still pretty good though.
I have to dump blood because my HGB and HCT are above normal (obviously I don’t take epogen), why?? I have no idea, I did need nominal epo when I first started but now, even with dumping a full line and dialyzer of blood a month and only using 250cc of saline to return blood (meaning the lines are not clear) my counts are still above normal.
Hey, Cathy,
I’ve known patients that had higher Hgb/Hcts than 11-12%, especially patients that exercised regularly and worked full-time. The doctor I worked with got approval for one of our working dialysis patients to have a higher Hgb/Hct while getting EPO because he was working. Having a higher Hgb/Hct helps people feel stronger, less fatigued, and have less shortness of breath. The 11-12% is the target range is what Medicare sets for someone on EPO. You’re not on EPO. What’s your Hgb/Hct before you dump blood? What is the reason why you dump your blood?
Do they have higher hemoglobin because they exercise regularly and work, or do they exercise and work because they have higher hemoglobin? How old are they?
It’s a “which came first, the chicken or the egg” kind of question
My experience with the thousands of members on my email group, many of whom I’ve followed the evolution of their chronic renal failure for years, even a whole decade, is that there’s just no pattern. I had kidney disease for 25 years before I started dialysis. I was somewhat more disabled than most near the end (with vicious hypertension problems for one), and yet, my Hg was pretty good. I didn’t need EPO until I was about 8 months into dialysis. But, I did start with a natural hematocrit of more than 50%. So, for me, even 40% was quite a drop. Other people I know who were minimally disabled had low hemoglobin and were on EPO years before dialysis or transplant.
Who knows. It’s hard to draw any conclusions about these things.
I have to say though, a dialysis patient having to dump blood monthly to lower hemoglobin is a first for me. I’ve never heard of that before. I guess anything’s possible, but I just can’t imagine any situation in which a kidney failure person’s hematocrit would be too high. I mean, just the dialysis alone makes you lose a bit of hemoglobin every treatment. I would be curious to know more about this. Have they given it a name?
I mentioned this already, but I didn’t need EPO at all until I had been on hemodialysis for about 8 months. And even after that, it only took 2000 units of Eprex (that’s about the smallest dose anyone is on). Eventually, the renal failure and the blood loss from the actual dialysis combine to make it such that our red blood cells can’t be replaced fast enough.
However, since going on daily nocturnal, my hemoglobin has increased dramatically, despite being on dialysis for so much total time on nocturnal compared to when I was in-centre 3 times per week. We all lose a bit of our blood to every treatment, but with daily nocturnal, and probably with short daily too, the condition of our blood is so much better that our red blood cells aren’t killed off as quickly. So, our hemoglobin rises.
Let me say at this point that I did not start this thread with my short daily vs noctunal data to argue in favour of one over the other. They are just facts which I have observed. You will have noticed that I never put down anything, including short daily. I merely make observations. I consider myself to be as much a short daily user as a nocturnal user. Both are there for me, and I can switch easily at a moment’s notice. In fact, I am constantly re-evaluating the advantages and disadvantage of one over the other for myself (not for others). There are times when I would just as soon be on treatment for a couple of hours in the evening rather than all night. What keeps me on nocturnal is primarily that I don’t want to have to go back on BP meds unless I absolutely had to… that, and also that I am now just too used to eating and drinking whatever I want.
When I say anything to the effect that on nocturnal I can eat and drink whatever I want, someone is always bound to come back and say they can too on short daily or whatever. But I’m only saying this in the context of myself. A lot depends on residual GFR and residual tubular function. I know I had to diet and follow a fluid restriction on thrice weekly conventional hemo, I did to a much less extent on short daily (but I did still have to take a phosphorus binder and I had to watch the fluid a bit), and I don’t at all on daily nocturnal. I’m comparing myself to myself, not myself to you.
It is my understanding with a high red blood cell count you run the risk of easier clotting, risking your fistula… My Hgb is in the 16-17 range (after the dumping and reduced daily return) and my hct is 47+.
Sadly I am not fit and do not exercise a lot, have a great deal of back pain and Knee and ankle pain making exercise very difficult. I still run a low b/p and high heart rate that is still being investigated, so energy is a big problem for me, so these numbers don’t really help. What also is interesting is that I have very low iron yet still have these counts, there is some belief that they are not real good red blood cells.
I was intrigued by someone on dialysis having to throw out blood. I wonder if there would be any place where they’d accept it for donation. I suspect the blood bank wouldn’t accept blood from a dialysis patient, but you could ask if that’s of interest to you. I hate to see good blood go to waste.
Here’s info on red blood cell counts and what can cause too high or too low red blood cell counts.
