Overnight therapy puts z's in dialysis for kidney patients

[okarol]

Overnight therapy puts z's in dialysis for kidney patients

Treatment - Slower sessions filter blood more thoroughly and cause fewer side effects

Monday, November 27, 2006

ANDY DWORKIN
The Oregonian

When workers at Vincent Jones' dialysis clinic asked whether he wanted to spend all night hooked to one of the blood-cleaning machines, he thought the idea was nutty.

"I can barely make 41/2 hours, and they want me to do eight hours?" said Jones, 72, a retired bus driver whose kidneys were damaged by high blood pressure.

"But I tried it. And I like it," he said "After four hours, I'd have to go home and take a nap before I'd feel OK. But here, after eight hours, I feel good."

Jones is one of a dozen patients in a 2-month-old nocturnal dialysis program at Southeast Portland's DSI Lake Road Dialysis center. It appears to be the first in-center overnight dialysis program in Oregon.

On Tuesday, Thursday and Sunday nights, participants nap, read and watch TV for eight hours -- twice the usual time -- while machines filter their blood at a slower rate. Patients bring pajamas, blankets and pillows to make beds out of the padded dialysis chairs, though it's hard to sleep hooked to the machines. A few people wear earphones or eye masks, while clinic staff dim the overhead lights and use flashlights to check patients.

Supporters say the slower, longer dialysis removes more toxins and is gentler on the body, leaving patients with less pain and more energy.

"The more dialysis the better," said Lana Shubina, the center's charge nurse. "Our kidneys are working 24-7."

More dialysis is the wave of the future. About 336,000 U.S. residents are on dialysis, including 2,500 Oregonians and almost 4,700 Washington residents, according to the federally funded U.S. Renal Data System. At least 95,000 patients start each year.

The number of dialysis users is projected to grow from 3 percent to 5 percent a year, fueled largely by an epidemic of diabetes. The disease is the main reason people need dialysis, said Dr. Michael Walczyk, a nephrologist with Northwest Renal Clinic.

While kidney transplants help some patients get off dialysis, donor organs are in short supply, and some people are too sick to get transplants.

"Until someone figures out how to transplant a pig kidney into people, I think we're stuck with dialysis," Walczyk said.

Fortunately, patients have an increasing number of ways to get dialysis, including daytime sessions, overnight treatments, machines for home use and peritoneal dialysis, which puts fluid in the belly cavity where a membrane in the body naturally detoxifies the blood.

Home dialysis, which is often done overnight, was more popular in the 1990s, when there were fewer dialysis centers. While dialyzing nightly at home is perfect medically, Shubina said, some find it difficult. Patients need specialized equipment, including the dialysis machine, chemicals and a water purifier, and someone to help with the machine. Many insurance plans don't fully cover the costs for home dialysis, she said.

So as more dialysis centers have opened, home dialysis has waned: 324 Oregonians and 548 Washington residents now dialyze at home, according to the Northwest Renal Network.

Most patients go to a center three times a week, where a boxy dialysis machine is hooked into their blood vessels. The machine uses fluid and an intricate membrane to pull toxins such as urea, potassium and phosphorous from the blood. The machine also removes pounds of excess fluid, another job normally done by the kidneys. Treatments usually last four hours.

"It's fast. It's hard. It's harsh on the body," Shubina said.

Taking fluid out fast can leave too little water in the bloodstream, causing painful cramps, said Dr. Susan Kauffman, medical director of the Lake Road clinic. Also, some medium-sized toxic particles that can tire patients are hard to remove.

The longer, slower nighttime treatments should remove more toxins but do it more gently, avoiding cramps and exhaustion, Kauffman said. Removing more toxins could also curb other harmful effects, such as having trouble thinking and hardening of the arteries.

Kauffman said the center has more nighttime openings for patients who meet a few criteria: They must have their doctor's permission, have been on dialysis at least one month, tolerate that treatment well, take any needed drugs and generally take care of themselves.

The biggest benefit of nighttime treatment may be flexibility, said Heather Stilley, the center's social worker. Surveys regularly show the main complaint about daytime treatment is the time it takes.

But night patients "have all their days free," Stilley said. "They can work, go to school, spend more time with their family, have close to a normal life."

By moving to nights, one woman was able to resume working, making her eligible for Medicare and able to get on a transplant list.

Switching to nights made it easier for 53-year-old Mike Schmitgen to keep working. Schmitgen has polycystic kidney disease, which killed his father and put him in the hospital a year ago when his kidneys failed. A supervisor at a Portland recycling firm, Schmitgen had to leave work early and rush to the dialysis center for daytime treatments, which left him tired the next day.

About two months ago, Schmitgen switched to nights and quickly started feeling better. Though it's hard to sleep, and he only catnaps, he has enough energy to leave the center and work 13 hours the day after dialysis.

"I wouldn't go back on days," he says. "No way."

Walczyk, who is not affiliated with the Lake Road center, said the exact benefits of thrice-weekly nocturnal dialysis are hard to know. Most studies of overnight dialysis look at people treating themselves at home at least five nights a week. But getting more dialysis could well be good, he said. And simply having another option is a bonus.

"What I think is nice about this is that patients have choices now," Walczyk said.

Andy Dworkin: 503-221-8239; andydworkin@news.oregonian.com
original story: http://www.oregonlive.com/metro/oregonian/index.ssf?/base/news/1164597907319630.xml&coll=7

[kitkatz]

Oh sure, then have no life at all, ever, since you have to be on the machine for eight hours a night in clinic!  I would turn into a human popsicle in the freezer clinic I go to after eight hours!   When do you get to go out and do stuff?  If I had this arrangement I would go in at ten oclock at night and dialyze 10 to 5, then try to get to work on time by 7a.m. Hmmmmm.  I do not think I could do it and still work.  Are these people working a nine to five job, or are they on disability?

[Russ]

Nocturnal is not an option everywhere.  To my knowledge, nocturnal hemo is not offered or supported in the Chattanooga area.

[Bette]

I would love to do this.   It would be a pain to be in the unit but It would be awesome to feel normal again.

[tamara]

I'm on nocturnal every second night(at home), and it's as close to normal as I've been since doing dialysis.

[goofynina]

But who would come and scratch my back and play with my hair until i fell asleep, i am sure they wont let hubby come in and do that for me (or would they) 

[jedimaster]

I'm on a home hemo to do it at night...just I have been unable to do it because anxiety....I wanna, though

[Zach]

My doctor asked me about it today.
I might be interested to try it, since it's still only 3-nights-a-week.

Always good to have options!       

But who would come and scratch my back and play with my hair until i fell asleep, i am sure they wont let hubby come in and do that for me (or would they) 

Conjugal visits, I'm sure!     

[Russ]

But who would come and scratch my back and play with my hair until i fell asleep, i am sure they wont let hubby come in and do that for me (or would they) 

I think it would be allowed as long as the hair isn't on your back.   

[goofynina]

But who would come and scratch my back and play with my hair until i fell asleep, i am sure they wont let hubby come in and do that for me (or would they) 

I think it would be allowed as long as the hair isn't on your back.   

ok, nevermind then,,,   

[Bajanne]

This is the kind of dialysis I would love to have.  Then my days would be totally mine.  I have no problem with sleeping on the machine.  In fact, my nurses are always waking me to make sure I am okay.

[BigSky]

I would try it if offered. 

Very doubtful it will be offered here anytime in the foreseeable  future.

[Kitsune]

Do these "medical professionals" think we are bloodless, feelingless Barbie or Ken dolls with nothing to live for except die-alysis? Oh, that's right, we re on dialysis at THEIR centers, so that means we belong to THEM.  Our lives should now be all about dialysis and "improving our outcomes" (in reality, that means improving their bottom line.)  Since they want us to sleep there now, what point is there in having relationships, pets or a private residence?

I think what they really want is to corral us all into nursing homes where they will give us a bed, a dialysis machine which will be on 24/7, and a 5 inch arm television with basic cable (with all the "offensive" material filtered out, of course.) After this, you will of course be so beaten down by your whole life surrounding dialysis, that you will stick your arm out to any yahoo with a needle

You don't want the mean-a$$ tech who yanks your arm and yells at you to "STAY STILL!!!" because you alarmed after you dared to move after you cramped from laying in that godawful "on your back" position that all those ratholes seem to think is so good for us 3 1/2 hours, who can't hit the broad side of a 747  sticking you? That's too bad, because "If we let you pick your technician, everyone else would want to do that too, and nothing would ever get done." This happened to me, and how I solved it was saying, "Okay, well, that's fine, but you know I'd really hate to infiltrate or need a fourth surgery in one year and have to find another center that can accommodate my needs better.

The benefits of sleeping in a dialysis center can include, but are not limited to:

1.  The "So what, if you have to go, I'm busy and you'll wait" program:

If you have to urinate in the middle of the night, you have to wait for the inexperienced (and that is who gets night shifts, sorry to say) night tech to put down her copy of "Ok!" Magazine or her romance novel,  get off her "working here to keep her welfare check" a$$ and unhook you and send you to the can.

2. The "Of course not, you can't have anything to drink or eat for 8 hours, you're on dialysis and you're under the care of these caring,informed individuals who don't want you to choke or gain fluid" program:

Even if you urinate normally, you're still not supposed to drink, end of story, Eating is a no-no, as well, as you are viewed as a child even a cup of pudding can cause a choking incident.

3. The "Say goodbye to your partner unless you see them in passing after you split up, and you'll never have to date again either" program:

This one is the best benefit yet! The eight hours three times a week you spend with strangers and dialysis technicians who are only there to earn their checks will put a strain on that pesky engagement, marriage or life partnership you have and will  most likely end it! Think about it, how much time that could be spent on a dialysis machine, do you waste cuddling, kissing, making love, or hugging?  With this program, that time could be cut in over half! And it will prevent you from having to date again once your partner gets fed up, since you will have to, nay want to tell any potential partner about your wonderful, beneficial, medically perfect, 3 nights a week nocturnal dialysis, which will cause most normal people to run like hell.

4. The luxurious accommodations you will receive:

Your dialysis center, which most likely will look, smell, and feel like a prison will be the perfect place to contemplate suicide, as your amenities will include a hard, broken-down dialysis chair which in some more upscale locations comes with a stained 5-inch arm TV with 65 wonderful channels. (Some locales will have basic broadcast only) However, to cut costs, and make your experience more enjoyable, you will be asked, no told to bring your own pillow and blanket, which must be minis, so as not to take up too much room. Not even a glass of warm tap water will be offered to you and you must stay in one position all night or you will be hollered at.

5. You will never have to have a hobby again:

You will find all those pesky trips, power metal concerts, et cetera that start in the evening to be a thing of the past as you enter your center. You will be amazed at your techs lack of empathy as they tell you to shut up "because there are new patients there" as you scream in hellacious pain as they attempt to take the cheap, lazy way out," twisting"" the needle to try and make it work, but ending up having to put another one in anyway, causing more swelling and pain to the site.

Sound good? No? Then, you my friend are non-compliant! Call 1-800-TOTAL-BS to find a concentration camp that thinks this nonsense will fly and to become compliant and reap all these benefits. From there, we will also give you the number of different suicide prevention hotlines that you will undoubtedly want to call after dealing with 8 hours of in-center hemodialysis every other day.

Seriously, whoever posted this obviously has never been on dialysis or they wouldn't want it either. This is just another attempt to make more money for the doctors who try and impose it on us. If 4 hour dialysis is hard on the human body and spirit already, what is so great about 8 hour dialysis? If my nephrologist asked, I'd tell him to jam it. What a joke.

[monrein]

Well, I feel very differently than you do Kitsune although I did laugh at your description of things.  I want to do whatever makes me feel as well as I can and I've just gone to daily (2&1/2 hours), five days per week.  I feel way way better and it's only been a week and a half.  My nurses are fantastic, really nice people, very caring and fun, respectful of patients and we can eat whatever we want.  They serve coffee or tea halfway through each run.

My first choice would be home nocturnal and cuddling would be mandatory.  I don't at all experience ESRD and dialysis as things that are or have been done to me but rather as a very unfortunate set of circumstances that I have to endure and actually make the best of so that my entire life is not stolen. 

It's understandable to be angry about the crappy cards we've been dealt and our system here is very different than yours so for sure I have'nt had your experiences but one thing I am sure about is that I don't want bitterness to further rob me of any speck of joy that I can squeeze out of life and my life at the moment has to include dialysis.

I also choose to do my own needles so that I can take the control of that stress out of the hands of any less than great needle pushing nurses (we don't have techs here doing needles).

I did laugh out loud reading your post K and you have a real talent for writing (and especially for hyperbole which is an honourable literary technique).

[flip]

My Top 10 reasons not to do nocturnal:

1) I still have a night life
2) I prefer sleeping in a bed
3) I don't want to worry about a needle popping out and no one noticing.
4) I feel fine with 3x hemo during the day
5) I don't want to give dialysis a bigger chunk of my life.
6) My doctor is only a couple of minutes away (same for Nurse Practitioner, Dietition, etc.)
7) I don't sleep well with needles and a blood pressure cuff.
I would miss a lot of my favorite TV shows
9) No family life
10) Nocturnal isn't even offered here.

[Treasure]

I hope, I hope I hope that in-center nocturnal comes my way soon. I have asked some of the corporate powers-that-be about bringing to the Bay Area. I would have to drive 2 hours each way to take advantage of this-- but I think it would be worth it, so I can return to full-time employment. I just interviewed for my first professional position, and having to work around my dialysis days was a bit of a sticking point. So 3X a week, in-center nocturnal would make a huge difference.

[cherpep]

My old center called it 'nocturnal', but it really wasn't.  So, beware of what they offer as nocturnal.  The latest you could arrive to the clinic was 8:00pm, but they really wanted you there by 6 or 7.  It is scheduled for Tuesdays, Thursdays, and Sundays.  They offered both hospital beds and dialysis chairs.  The treatments are a minimum of 6 hours, most are 8 hours.  Who goes to bed by 6 or 7?  I would arrive by 7:00 and have 6 hours of dialysis.  I work full time, so I pretty much just went to the clinic right after work.  I didn't think this was nocturnal, this was spending my evenings at the clinic.  For the most part, even though I tried, I could not sleep until about 11:00 or 12:00.  So, if I was lucky I would get about an hours' sleep before having to drive home at 2 or 3 in the morning, get a couple more hours of sleep before getting up for work.  I felt horrible all the time!  I much prefer home hemo dialysis.

[Rerun]

I have done every form of dialysis.  PD, 4 hour Hemo, home hemo, 3 hour hemo, transplant and 8 hour in center nocturnal.  OK, I haven't done Nx stage.  BUT....  Next to a transplant the 8 hour in-center  hemo is the best.  I feel safe, I watch my movie and eat my snack.  I suppose it depends on the staff, but I have the best nurse and tech there is.  They joke around and let you do pretty much anything except bring in a live chicken to eat.  I sleep pretty good.  The best thing is I feel so much better and I don't have the fuzzy thinking and wiped out feeling.  I'm glad it is an option for me.  I've gone on vacation and had to return to the 3 hour sessions and it sucks.

[del]

Hubby hates having to do short sessions now especially in center!!  He does nocturnal but has a machine at home.  He has his life back. And yes at home you can cuddle!!! He sleeps through the sessions most nights and his bloodwork is awesome.  He is much more free with his diet. Basically he eats whatever he wants. This was not the life he would have chosen but hey it's the cards he was dealt (might have been crappy) and we are making the best of it.  He has a very positive attitude ( most times) and that is a big help! 

[Rerun]

You can have a somewhat "positive" attitude when you feel half way decent.  My attitude has improved since I've been on nocturnal.  I actually care if I live now.  I still hate dialysis.....that has not changed.

[del]

I don't think anyone "likes" dialysis rerun.  My husband has been very lucky and we are both very thankful for that. In 11 years he has had one period when he was sick. That was when PD stopped working. He came very close to dying.  Hemo has been really good for him and nocturnal has been excellent.  He does not have any other health issues so that has really helped. I know other people who are on dialysis and no matter how well they try to look after themselves it doesn't seem like anything helps and they have an awful time.  Each person is different and different treatments work for each person.  I'm just thankful dialysis is available so that hubby is still here with me!!

[Kitsune]

I do have a positive attitude, and I'm also positive that I'd rather eat dirt than spend my night in a dialysis center in a rock-hard chair with a blood pressure cuff on and needles in my arm for 8 hours. I can barely take the 4 hours twice a week I have now. Also I tend to like to party with my soon to be husband at night and we all know that a dialysis center's idea of partying is cheering when the USA takes the gold in the Olympics as you raise your 1/2 cup of piss warm water. Also, I like sleeping with the man I'm basically married to, so what makes them think that a young person who already has good labs is going to decide that sleeping in a comfortable bed with no needles and no BP cuff is going come for more treatment? Good grief, someone slap these people, they have no clue what young people think. Oh, right, yes they do....we think about dialysis 24/7 and hope one day they wil come up with longer and more personally invasive ways to dialyze us so we can be at a place we hate instead of having a life with someone we do love. Well they can kiss my  , because I'm not doing nocturnal, not now, not ever.

[monrein]

No one HAS to do nocturnal.  Doctors aren't saying "Do nocturnal, we want to torture you longer".  WTF???  It's an option.  And a good one at that for many people.  Not for ALL but for many.  Like PD, or hemo, or daily or whatever.  An option.  It's NOT some medical conspiracy.

Also many "old" people like to sleep with their partners too,  we like comfortable beds and no BP cuff and we too have better things to do than dialysis.  I've been on dialysis young and now much older but my age hasn't changed too much in terms of how D interferes in my life and derails me from my preferred way of living.  Old people aren't that much different than young people, they're just older and hopefully a bit wiser but even that isn't a given.  They come in all varieties, just like young people.

[Chris]

The only offense I have with Kitsune on her first post on this topic is the statement "Seriously, whoever posted this obviously has never been on dialysis or they wouldn't want it either." 

Apparently you haven't been here long enough and to make that assumption of Okarol who posted it is dead wrong. First of all, it is a news article concerning dialysis, which is a concern of this site. Okarol takes time to post any news regarding dialysis or transplantation and belongs to other dialysis related sites. If you take he time, you'll find many post by her regarding various news articles and will also post research she found regarding a question that was asked. Secondly she does have experience with dialysis. Not personally going through it, but having her young daughter gone through it.

So now comes the famous quote that fits, "assumption is the mother of all f*@$ ups" And this one hit it right on the nail big time.

[Kitsune]

No one HAS to do nocturnal.  Doctors aren't saying "Do nocturnal, we want to torture you longer".  WTF???  It's an option.  And a good one at that for many people.  Not for ALL but for many.  Like PD, or hemo, or daily or whatever.  An option.  It's NOT some medical conspiracy.

Also many "old" people like to sleep with their partners too,  we like comfortable beds and no BP cuff and we too have better things to do than dialysis.  I've been on dialysis young and now much older but my age hasn't changed too much in terms of how D interferes in my life and derails me from my preferred way of living.  Old people aren't that much different than young people, they're just older and hopefully a bit wiser but even that isn't a given.  They come in all varieties, just like young people.

monrein,

I'm not talking people in their 40's-60's,  I'm talking 80-90 year olds who go home to nursing homes or whatnot anyway. From what I've seen of nursing homes, the only difference would be the needles and the BP cuff. Let those who have no family or partner do it, it will save room during the daytime for those of us who actually have something to go home to besides a picture of a adult child who never visits or a spouse who died 40 years ago.