Versatility of txs

For those who switch back and forth between SDD and SND how often do you do so? We were surprised when we called Lynchburg to inquire about how they train, that they only train nocturnally and do not train for SDD at all.

For those who do nocturnal, do you find that when switching to SDD that you feel less well until you get back to nocturnal? Do you have any problems as far as dw and goal, diet?

I thought I would reply to this because switching between short daily and daily nocturnal is possible anytime. It’s not a daily nocturnal hemo program, but a home hemo program. It’s pretty much left up to the patients as to whether they do short daily or daily nocturnal, and the number of days can vary too.

While I prefer daily nocturnal, I very much like the fact that I could switch anytime. Our Fresenius system is very capable of both without any modification or adaptation of any kind. We all train doing short daily first, we do short daily to start at home, and then those who want to go to daily nocturnal then go on to sleepover 3 nights at the hospital.

In practice, I would never do short daily unless I had to for some reason, but it’s nice to know I have that flexibility available.

I did short daily initially at home for about 3 months before switching to nocturnal. Since then, I’ve done short daily for a week or more at least a couple of times. Both times, it was necessary for a technical reason. For example, at one point, there was a batch of bloodlines which couldn’t be trusted overnight because there had been a few cases in-centre of a connector becoming detached. So, until that problem was resolved and they could replace our bloodlines with another batch, all nocturnal patients had to do short daily instead (which was MUCH better than going in-centre!). More recently was when I had to create a new buttonhole. Plus, there have been a few times when I chose to do a short daily instead, such as when I wanted to pick someone up at the airport late at night.

It hasn’t happened yet, but I might decide to do a short daily in the morning if I had a power failure or something at night. It would depend on the circumstances.

Like I said, it’s nice to have that flexibility.

Overall, I probably don’t feel that different during short daily stints, but my bloodworks isn’t as good. The big difference medically is that my blood pressure goes up on short daily. If I was on short for the long term, I’m pretty sure I would need a BP med as I did during my first 3 months at home on short daily.

Dietwise, it’s the same, but fluidwise is very different. I drink whenever I want on daily nocturnal, but I do watch it a bit on short daily. This is because there just isn’t as much treatment time to remove fluid, and I don’t like to have those higher UF rates when I’m too heavy.

I prefer daily nocturnal mainly for 3 reasons:

1- Medications: I don’t need any BP meds, and only minimal Eprex. No phosphate binder. Furthermore, I can eat ALL the phosphorus I want without exception.

2- I can drink anytime I want.

3- All my daytimes are free.


I do a short run most weeks on a Sunday sometime along with my 3 or 4 Nocturnals. As we are going away for a night up in the “big smoke” on Sunday this week so I simply swop around and am doing a short run today (Friday) and a Nocturnal Saturday and skipping Sunday. Works beautifully for me.
Short runs I still only get my blood pump speed up to low 300’s and take off around an average of 500ml/hour but I do feel different when I come off. Feel a bit light headed but otherwise okay. I have never run higher than around 320 blood pump speed and have been on dialysis for less than a year. I want to work up slowly and so far this is working well for me. Nocturnal with the Freni certainly has given me this flexibility and for that I am very grateful.
Cheers 8)

Similar to Beachy, I do a 5-6 hour run on Sunday evenings, as well as my M/W/F overnight 8-9 hours runs. Since I have occasional cannulation problems, sometimes they are troublesome enough to defer the session, go to bed & do a day run next day…O.K. for me, as I only work M/W/F anyway, so Tue/Thur & obviously Saturday are always available for dx.
THe flexibility is one of the best things about home haemo - the others being good clearances & no dietary restrictions. I’ve started later (midnight) if we’ve been out for dinner; swapped nights for other social events. I will probably do a short daytime Fri instead of full night, if we go away for the weekend too, taking a day’s leave. Then do a full night Sunday.

What does SND stand for?

Bear, do you always do the short run once a week?? I was doing 10hrs 4 nights a week but I couldnt cope, so have gone back to 10hrs every second night. What does the HTHU peeps think of doing a short Dx once a week? Does it affect nocturnal blood figures? And do you use the same dialysate for the short run? I wouldnt mind giving that option a go if its something that can be done regularly.

SND stands for Slow Nocturnal Dialysis.

Oh I see, I’ve never heard of it being called that

Well, doing one short run shouldn’t affect the blood figs. too much…anyway, Janine said 5 hrs was too short, at least 6 was necessary. So I try to get on by 6p.m. Sunday…off at midnight, bins out & off to bed by 1a.m. :smiley:
As for M/W/F - I can’t do 10 hours, as I’m running dialysate @ 500, so I get alarm for low acid about 1.5 hours before coming off & have to take the funnel out of the jerry & drop the wand in; then I’m running out of bibag contents by the end. Sometimes (if I’ve taken a bit too long cannulating) it runs out just before the end, so I end up just UFing for the last 10 mins or so.

Bear, I have set up my routine so I dont run out of dialysate. But of course if you have cannulation problems well its a pain in the butt as theres no leeway with extra dialysate.
I dont use the funnel, no one told me too, I just have the whole cap off. After 10hrs there is about 1cm left in the bottom and about an inch of bicart left. Ive been told I need to do 10hrs, because when I started cutting back to 8, and then I missed a treatment one week, I ended up in ER with a K+ of 6.8 :shock:
So I will gladly do 10hrs, plus any less and I get even less sleep than I do now, even now Im only getting 7 and its not enough.
I did an experiment this morning, I was awake around the time when the machine was due to scream at me to hit the bicart and I wanted to get back to sleep, so instead of waiting for it to alarm and wake me up, I gave it a bash anyway, and guess what, it didnt alarm!! I think I might “pre-bash” it just before I go to sleep, hopefully its enough to keep it going til morning.

Yeah…if there was enough fluid to run 10 hours, I probably would & get the extra kip. :smiley: …I have thought about opening a 3rd one & just putting an extra liter or so of it in the jerry. But then the BiBag is still going to run out before 10 hours. Is there such an animal as a 1250 BiBag ? :smiley:
Anyway, they seem to be happy enough with the bloods, so far (I know I am). So my ‘regime’ must be O.K. for now.

Oh ok, the fresenius must be a bit different?

Bear, if it looks like I going to be slow at gettig on I just press the flow button off for a while(about 10 mins at most). At 300ml dialyste flow rate if i leave it on I figure I have about 8 3/4 hours from when I start circulating.

Yeah, I turn the flow off too, if I think about it. If the previous session was a problem getting on, then I probably do…but if I am ‘confident’ I don’t think about it…& then I might have probs. :lol: