How Much Dialysis is Enough

© 1997 Andrew Lundin, M.D. All rightsreserved. Reproduced with permission.

Consider that, at its best, a standard hemodialysis treatment today replaces about 15% of normal kidney toxin removal. This is about the level where those still relying on their own kidneys begin to get symptoms of uremia. As one can appreciate, we on HD are always close to being uremic again. It is the URR of >65% or Kt/V of 1.4, consistently received, which safely keeps one away from becoming uremic again. If and when a more efficient dialysis can be given the safer one will be and the better one will feel. With the current methods of HD, improving efficiency means taking one of a number of steps:

1. bigger dialyzer

2. more time on HD

3. higher blood flow

4. higher dialysis fluid flow

5. greater frequency of dialysis (?daily)

As those of you who have experienced HD know, doing these things means a trade off in convenience and comfort. There is also the cost and economic element.

When I started on dialysis, I dialyzed for 10 then 14 hrs three times per week. Ask Ron Bull. Then the time was lowered as the dialyzer got bigger and the blood flow higher. This was all done with attention to keeping the subjective equivalent of the URR (not used at the time) high. However, as the 4 hr treatment time became the economic standard the dialyzers started decreasing in size also for economic reasons. Those who were not paying attention to how their patients looked and felt controlled the market and large dialyzers all but disappeared. Large dialyzers are back but are often used to shorten the time. If the 2 1/2 to 3 hr treatment time becomes standard, watch out if smaller dialyzers are again used.

Since returning to dialysis I am getting the highest URR ever at about 70%. I feel great and my appetite is as good as with the transplant.

 

Peter Lundin, M.D.

 

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