Luck or not?

[Phil]

I have a question for you guys....so I've been doing in-center HD for 5 months, 3 times a week, 4 hr MORNING sessions. I have pressure drops roughly once every 7/8 sessions....but usually only when I try to take more than 3.2 Kgs off. After my session I feel ok...I have lunch, but after lunch I need to sleep a few hours to reset. When I wake up I'm ok. Not great but ok. On my non dialysis days i feel great. Now....here's my question...the other day I had to leave town for work, and therefore do my HD session in a center out of town. I did a afternoon session....it went GREAT! I even had a pressure drop during the session....but I didnt feel anything....normally if my pressure drops below 105/60 I feel TERRIBLE straight away...during this session it dropped to 90/60 and I didnt feel a thing!!! At the end of the session I was worried that I'd need my usual nap, and that work would be a problem....but I felt fantastic! I felt like I do on my non dialysis days....even after a pressure drop!!!!! So this got me thinking.....could afternoon sessions be 'easier' on my body? Perhaps the fact that in the afternoon you do your session AFTER having had lunch your body holds up better..... ? OR did I just luck out and have a really good session??? Your thoughts?

[jbeany]

It might have a lot to do with your body's natural sleep schedule, too.  If your morning sessions start at the crack of dawn and your natural inclination is not to be a morning person, then the lack of sleep is going to make the sessions that much more tiring for you, regardless of crashes. 

[KICKSTART]

I used to do mornings which meant getting up around 5am , then i got an afternoon slot which seems a lot easier to do !

[RightSide]

It also depends on what you've eaten.

By the afternoon, you're "fueled" by lunch.

[greg10]

..OR did I just luck out and have a really good session??? Your thoughts?

Welcome to the forum.
This is not really due to luck. There is a circadian rhythm to most organisms and there is a significant higher frequency of cardiovascular events in the morning than there are in the evenings for the average person.  This holds true with dialysis patients as well as the 'normal' population.
http://www.ncbi.nlm.nih.gov/pubmed/18155533

Time of death could be defined in 873 of 927 deaths (94.2%). In 459 prevalent hemodialysis patients, morning deaths occurred 24.8% more frequently than expected (P < 0.001). No similar excess was observed in the 414 incident hemodialysis patients (P = 0.9). In logistic regression, significant predictors of death occurring from 4:01 am to 12:00 noon in all subjects were being an outpatient
*prevalent (>3 months on hemodialysis therapy)  and incident (<or=3 months on hemodialysis therapy)

[Bruno]

I've had a lot of what you mention...blood pressure dropping...I've had it happen just after I hook up and sometimes near the end of a session and there are various explanations. I got to the stage where I would sit with the BP monitor strapped to my arm and my saline infusion notes nearby. I find I need to do something if my BP is below 80, around 100 I can handle and I've now got to the point where I can tell without the monitor how I'm travelling.
At startup, the explanation is simple...You can't drag blood out of your body like that without some reaction from your body...I got around that by connecting up and leaving the prime saline in the system...I get a saline boost to start.
The other instances I have overcome by making sure I know my dry weight and manage my goals very carefully, but most importantly (for me anyway) I try not to take off too much at one session...so that I have a UF rate of no more than 300 to 400 per hour.
A good indicator of what might happen is your blood pressure before you start...if its down you need to be cautious.
At present I'm a morning Dialyser, my BP is normal going on and coming off and I no longer have BP variations. But like everybody, I still have good and bad days...I've given up trying to work out why.

[kitkatz]

The butt crack of dawn is an awful time for me to dialyze.  I need evening shifts.  Otherwise I am wiped out the rest of the day.