True Or False ..........

[ToddB0130]

........ there is no difference between 3 times per week in center nocturnal hemo (6 to 7 hours per run) and 3 times per week  in center hemo on a 3 hour run time

I know this sounds like a dumb question,  but before I tell you WHY I'm asking,  I just want to get some feedback.   THANKS

[amanda100wilson]

I would say false, based on anecdotal info. About longer dialysis.

[willowtreewren]

False!

More time is better. The longer runs allow more of the larger molecules to be removed.

Aleta

[MooseMom]

False; am looking forward to you revealing why you are asking. 

[boswife]

False!  It takes more time for the larger molicules to be rid of,  AND it is run slower so as to put less turbulance on your fistula AND the fluids can be taken off slower so as to not stress the heart   

[ToddB0130]

Okay --- I won't wait for more 'falses' .........but others can feel free to chime in.  I agree it's 'false'


Why am I asking ........my NEPHROLOGIST told me this last Thursday.  I''ve been seeing him for six years and at my last visit we talked about my upcoming D plans.  I told him about the clinic I found that is 'in network' and offers nocturnal runs (three times a week, 6 to 7 hour runs).

He seemed taken aback that I wasn't using the clinic his practice has partial ownership in.  I'd already told him that his clinic wasn't 'in network' for my insurance and I wanted to do a longer, gentler run (hoping to get to home hemo sometime down the line).  He started the drill about the clinic's financial person 'working with me' and the clinic offering an 'evening' shift (5 to 8 or 6 to 10, I think).

And when I brought up the "longer is better" argument, he hemmed and hawwed about it not really being the case !!  And was saying what a time commitment it was and that finishing up in the early morning hours would affectt my sleep, etc.  A HARD SELL !! (hey, if he'd pay the THREE TIMES costs involved in going out of network,  I'd consider it !!)

Long story short,  I told him I was sticking to my plan and if I wanted to change it down the road, I could ....... he finally settled it by saying 'it's your choice and I'll work with you, but you'll probably need to set up monthly visits to see me since I wouldn't typically be seeing him at that clinic while I was doing nocturnal'.

Unbelievable, right ??

[Willis]

To some it's all about the money. If you go to the other clinic then he loses out. And most docs have no clue how much the drugs they prescribe cost. (sorry, off-topic, but sorta related.)

 

[Rerun]

What a racket.  I wouldn't even go see him again.  See another Nephrologist at the new clinic.  Sorry but he does not have your best interest at heart.  His final thought was "I'll still get the monthly fee of $345 and he will have to drive to my office".  Don't do it.  Find a new kidney specialist.

   

[cassandra]

I aggree with Rerun, just a moneygrabbing, selfobsessed dr, And doing a longer, lower pump-speed D will keep your heart in a better condition too

[thegrammalady]

i run 7 hours, 3 times a week, in center. i went over a year without binders. i eat pretty much whatever i want. i haven't crashed in over a year. i don't leave dialysis, go home, throw up and sleep the rest of the day.  what can i tell ya, that doctor is just plain wrong! find a new one.

[MooseMom]

OMG...that's just immoral!!!

[lmunchkin]

Hands down, just get a new neph and one that has a heart!

lmunchkin

[bevvy5]

There is a study that suggests that basically nocturnal patients, not sure how many hours a week in total, live as long as those who have a deceased donor transplant.  That's way better odds than conventional hemo.  That was one of the points hubby's neph made in convincing him to change from PD (which wasn't working at all) to home hemo and then nocturnal. 

We're pretty new at it, but since he has increased his hemo from conventional in centre 12 hours a week (he had to start as PD failed completely) to one overnight run a week and four times a week during the day (while we're in training for needling his fistula), he eats and drinks what he wants.  Actually had to change his prescription as his potassium was too low.  Not taking binders/calcium anymore, his phosphorus is good.  We expect even better results re urea/creatinine and clearance once we make the full jump to 40 hours of nocturnal a week.  He's started a new exercise regime to get back some o the mobility he's lost in the last two years because he doesn't feel like crap all the time.  We just got back from Hawaii - we thought we'd need a walker or scooter for him but he was able to (with some accomodation) keep up with the group.  Based on previousl experience with conventional hemo, those are all huge leaps ahead of where he would have been without the extra dialysis.

One of our nurses made an interesting point the other day.  In reviewing bloodwork of another patient he mentioned that he actually had to see what "normal" urea and creatinine levels should be for him.  It's not something that renal nurses usually need to do - it's never in the "normal people" normal range.  He's pretty new to the home hemo team and our sweetheart of a nurse told him that's not that unusual for people who dialize nocturnally as they should.

Disgusting that it sounds like it's for the money.

I think this is  a link to at least a synopsis of the study I was mentioning:

http://ndt.oxfordjournals.org/content/24/9/2915.full

[looneytunes]

My hubs started nocturnal in-center and we have just finished our 3rd week of 3 nights, 8 hours per night.  We both can say he is definitely improving.  His energy level is much better and his labs are already showing some improvement.  We had been doing home hemo with NxStage for almost 2 years before the change to nocturnal, necessary because he was no longer getting adequte dialysis with 24+ hours a week on the NxStage.  So...I am in agreement ....tell that neph to eat your dust and find another neph who doesn't have a financial interest in any clinic. 

[mogee]

In Canada the profit motive is not part of the healthcare system so abuses like the one you describe does not occur.  I've been on nocturnal dialysis for more than seven years and I am actually healthier today than I was before I began dialysis.  Among the benefits of nocturnal dialysis is the lack of dietary and fluid restrictions and the ability to go without dialysis for longer periods if needed.  I have gone five days without dialysis and still felt fine except for the anxiety of not knowing when my next treatment will take place.

[M3Riddler]

........ there is no difference between 3 times per week in center nocturnal hemo (6 to 7 hours per run) and 3 times per week  in center hemo on a 3 hour run time

I know this sounds like a dumb question,  but before I tell you WHY I'm asking,  I just want to get some feedback.   THANKS

Kidneys work 24/7.  Dialysis will never do what the kidneys do.  In center 3 day treatments are less than adequate. The longer, more frequent dialysis, the better.  12 hours a week ( a typical in center treatment per week) is just not enouph. Your labs may be good right after the treatment, but this is because you are testing blood that has just been cleaned. If you wait for the body to equilibrate back to its normal homeostasis, you will see your labs will be much different than drawing them immediately after the treatment.    More dialysis is always better.     

[Bill Peckham]

....... he finally settled it by saying 'it's your choice and I'll work with you, but you'll probably need to set up monthly visits to see me since I wouldn't typically be seeing him at that clinic while I was doing nocturnal'.

Unbelievable, right ??

There is the reason right there. If you were at his clinic he could 'round' once a week and get paid the Medicare rate for four or more visits a month, about $300/month allowed. If he sees you only once a month in his office then he'll be reimbursed about $200/month.