3 days a week of Hemo not enough.

[kristina]

kristina, those questions have been asked for a long time now, and the answers are usually bound up in economics.  There are many papers written on this subject, and here is one that you might find interesting.

http://ndt.oxfordjournals.org/content/26/4/1128.full

It's a bit long, so I'll just post the link.  It is easy to read, though.

Thanks MooseMum, very much appreciated.

[Hemodoc]

Sadly, since 1973, it has not been about patient outcomes, but Large Dialysis Organization profits as Dr. Scribner and Dr. Blagg have testified for years. They went from home hemo 24 hours or more a week for $7000 a year, to less than 12 hours in-center for $29,000 as noted in Richard Rettic's reviews of dialysis in the 70's.  Tell me how that happened by congressional approval?

[Bajanne]

I must say that hearing this does not make me very happy.  I really want to be around for quite a while more.  And I am a Mon-Wed-Fri!  Lord, help us!

[Iwannabean]

I am currently on a M/W/F schedule, I work full time 7am - 3pm, dialysis 4pm-8:30pm.  Saturdays, I am recovering, Sundays are my best days and Mondays I am playing catch up again, exhausted and ready for bed by 10am. Although I would hate to do it, I would rather be dialyzed 4 days a week vs. three.

 :urcrazy;Iwannabean

[MooseMom]

No one wants to be stuck on a machine for more hours than is absolutely necessary.  Dialysis is not fun.  Most people hate every minute of it, so to even contemplate EXTENDING the time on dialysis can be horrifying.  But at the very least, patients should KNOW the pros and cons of every modality, and patients should then make their choice.  We gripe about dialysis being too "cookie cutter", and the only way to combat that is to think very carefully about whether the dialysis we are getting is the best treatment.  Do you want the best treatment?  Do you want the best medicines, the best medical staffs, the best weapons against your disease?  No one, and I mean NO ONE really thinks that thrice weekly incenter D is "the best" dialysis, but that is what most of us are offered by people who don't really sit down with us and tell us there are other ways of doing things.

I remember how my mom and I exulted when she was told she should shave off 15 minutes of her time at the clinic.  OK, so I was stupid back then.  She should have refused, but we didn't know the consequences.  She was offered nocturnal by a nurse they brought in to start up a nocturnal program, but the head nurse nixed it, and I'll never know why.  I'm convinced that her congestive heart failure could have been avoided if she had received MORE dialysis, not less.  What I wouldn't give to have the opportunity to do that over again.  I would have pushed the clinic for an explanation.

[tyefly]

when I started in center  I was doing three hours  three days a week.... I felt great.... compared to when I wasnt doing dialysis.... they tried to get me to do 4 hours in center and I refused... knowing that I was going to start training for Nxstage and doing it at home..... in three months I started Nxstage and was doing short daily and doing 2.5 hours a day using 20L.... after three weeks I did not feel good.... I felt better in center doing the three hours three days a week... I suggested that I run with more dialysate...and got them to agree to letting me do 30L.... and of course that extended my time cause of the amount of dialysate.... I went to 3.5 hours....  plus I slowed my speed down because I was concern about pressures....  they were too happy about that as they thought I should run 430 blood flow speed... I want to run 380 to keep my pressure down and keep the alarms at bay.... I found that running at high flow rates would give me too high of pressures and I would have to hold my body and arms completely still ... That was not fun .... I like to do things while do dialysis..like computer, crafts  or what ever....I was doing short daily six days a week....  that was very hard to do everyday....4 to 4.5 hours a days with the decreased blood flow speeds....  Then going to nocturnal  and doing 7 hours at 300BS and sleeping while I was do dialysis was just the ticket..... not only did I free up my day  but I didnt have to sit there every day for hours.... its hard for me to sit.... I dont know how you people do it ..... 

If I had to go back to dialysis I would have to insist that I do it nocturnal again..just so I didnt have to sit all those hours...  sitting all those hours makes a person want to do less...it hard very hard to sit there... I dont think I could.... its so depressing. so controlling..so hard on the body to not move around....

Even though more dialysis is better  getting people to want to do more and having them sit there longer is something that I dont think most people would want to do...    its so hard to convince people that more dialysis is better.....

[MooseMom]

The bottom line is that normal kidneys work around the clock, a little at a time and at just the right speed.  When normal kidneys are working as they should, we feel good.  When we have to use artificial kidneys, we have to make a choice regarding how closely we are willing to have that artificial kidney match what normal kidneys do, and whatever we decide, we have to understand the consequences of those decisions.  We are the ones having to live with our choices.  The problem, though, is that most of us don't have many choices.

I, too, don't like the idea of sitting for 4 hours each day while dialyzing; that just sounds sedentary and unhealthy from the get go.  And that's why, like you, tyefly, I am going to be working toward nocturnal home hemo.  I am just hoping that I don't have to fight too hard to get what I want.

[Stoday]

It's well-known that the French invented the metric decimal-based system just after the French Revolution in 1789. What's less known is their invention of the revolutionary calendar, also based on decimals. This calendar died some 14 years after its initial adoption.

ESRD patients would have got on well with the Revolutionary calendar. A week lasted 10 days, so all could be dialysed every other day without a glitch at the weekend. Moreover, there were ten hours in a day, so patients would get their full dialysis after only 1⅔ hours instead of 4.  All months had 30 days, so the day of the week occurred on the same day of the month for every month.

Today is Quintidi 5 Vendémiaire CCXX

[lmunchkin]

I like the fact that it is our choice!  If hubby wants to lay down and Dialysis, he does.  If he wants to sit, he does that too!  He will sit up and eat and then sometimes he will lay down and nap.  I never really thought that was a problem with Home D. just In-Center!  The nocturnal is what I can not do for him, because of my job.  I don't think he wants it anyway, cause when he did PD with cycler he never rested well.

lmunch

[mamba]

I TOTALLY AGRRE WITH THE PREVIOUS SPEAKERS.  THE 3 DAYS SCHEDULE IS NOT ENOUGH FOR PEOPLE IN DIALYSIS.  DIALYSIS TREATMENT HAVE TO LOOK LIKE THE NORMAL KIDNEY OPERATION.  THIS MEANS THAT A KIDNEY PATIENT SHOULD HAVE A 7 DAYS DIALYSIS PROGRAM FOR 3.5 HOURS. CAN YOU IMAGINE STH LIKE THIS? FIRSTLY THE STATES AND THEIR CITIZENS WHO PAY TAXES CANNOT AFFORD THIS COST. MOREOVER IT 'S DIFFICULT FOR HUMAN VESSELS AND CIRULATORY SYSTEΜ TO ACCEPT THE USE OF A "PERMANENT" PUMP OF DIALYSIS MACHINE.
I AM SO GLAD THAT ONLY 3 TIMES/WEEK PER 4 HOURS DIALYSIS ARE ENOUGH TO COVER MY KIDNEY FIALURE.  30 YEARS AGO DIALYSIS PATIENTS HAD TO FOLLOW A 3 T/W PER 12 HOURS PROGRAM AND THE DIALYSATOR HAD THE SCHEME AND DIMENSIONS OF A BED.

[lmunchkin]

Mamba, I don't know how things go in Greece with the D. clinics, but the majority in the US are pitiful.  If you prefer the 3 days vs everyday, that is your choice, but mine is to do it at home 5-6 days a week.  I can see a significant differents in my husbands health, that was not reflective in his In-Center experiences.  That was our choice!

And we just love to be within our home surroundings rather than a group of chairs with people strapped down!  The rules in Greece for In-centers may be better than in America, because they don't allow these people to do much of anything while Dialysising.  Can't even allow family members to sit with the loved ones!  That was always hard to swallow, cause I wanted to be with my husband and Vise versa!

Im glad that 3 days a week works for you, it just didnt for us!  There are lots of people on IHD that still do In-Center!  It is a matter of choice! We just love the home experience.


God Bless,
lmunchkin   

[tbarrett2533]

And we just love to be within our home surroundings rather than a group of chairs with people strapped down!

Im glad that 3 days a week works for you, it just didnt for us!  There are lots of people on IHD that still do In-Center!  It is a matter of choice! We just love the home experience.


God Bless,
lmunchkin   

MEEEEEEE TOOOOOOOOO!!!!!!     I can't even stand the smell of my center!!!!!  and I feel so much better on PD!!!!! I love it!!!!!!!!!!

I hope I NEVER have to go back to In-center Hemo!!!


There sure is no place like home when it comes to dialysis!!!!!!!!!!!!!