Haemodialysis Sessions

[Bajanne]

As I explained in another poll, I am on for 4 hours.  They say this can be shortened if I have good 'clearance'.  I am just wondering how long you guys are on per session.

[LifeOnHold]

Almost everyone in my center is on either 3 1/2 or 4-hour treatments.  I can't see how that could be right-- if everyone is so 'different' in how much dialysis they need, shouldn't some people be on 3 hours and 18 minutes, and some be on 4 hours and 3 minutes?  Why do they think the human body functions on the hour and the half hour???

[O in]

Almost everyone in my center is on either 3 1/2 or 4-hour treatments. I can't see how that could be right-- if everyone is so 'different' in how much dialysis they need, shouldn't some people be on 3 hours and 18 minutes, and some be on 4 hours and 3 minutes? Why do they think the human body functions on the hour and the half hour???

hi dear lifeonhold
if you check the time control on you dialysis machine you will see that there are times when treatment is shut down to enable the machine to do a function check and this will be noted on the clock screen when your session is completed as "diff time" in minutes
it is usual for a four hour session to have a diff time of 9 minutes so you not being held to those half hour breakes because you are only gettin treatment for four hours LESS 9 minutes

my five hour session has a diff time of 11 minutes so i am not really getting five hours of treatment at all only four hours fourtynine minutes but the session run time is five hours

[babi68]

Hi all,
     I also do five hours. I use a HDF machine. Not sure what you guys call it. It has two pumps. There are only a few of us who do five hours, most do 4. I hate it as we turn up at the same time and get on, and then I sit back and watch everyone leave.  It is better for you the longer you go. Liz

[Epoman]

3 hours for me but if I let them I would be on 4 hours. I tell them they can bite me when they try to get me to run longer.

[susie q]

My sessions are 4 hours.... The last half hour is a killer...
I want to just do 3.5 but I know it is better to do 4..
I am too chicken to ask the dr..  he has most patients do
4.5 or even 5 and I do Not want that...

[Bajanne]

Well my nephrologist said that my 'clearance' has improved.  He said that good 'clearance' is from 65%, and mine is now 69%.  Woohoo!  He also said that if my 'clearance' reaches 75%, then my time would be shortened.
I am going to my next question and hope someone can explain succintly exactly what 'clearance' is.

[O in]

Well my nephrologist said that my 'clearance' has improved. He said that good 'clearance' is from 65%, and mine is now 69%. Woohoo! He also said that if my 'clearance' reaches 75%, then my time would be shortened.
I am going to my next question and hope someone can explain succintly exactly what 'clearance' is.

well i guess to each his/her own but sayng 65% clearance is good wouldnt pass in nz
but then the dialysis service here dosent have to push 3 hour session paitents out the door to make enormous profits
me i will stick to my five hours i know that i feel a hell of alot better than i do on a four session not only during the session but for the rest of the day - a marked differance to the crappy feeling a lot of you seem to be saying you experience

on the matter of thirst - i tried ice didnt like it! - tried freezing orange juice but ittasted awfull so what i do now is severly restrict fluid drinking and put manderin segments or grapes in the fridge and use the as the main fluid intake - dont leave the in the fridge more than 36 hours because they loose their taste.

[Epoman]

Well my nephrologist said that my 'clearance' has improved. He said that good 'clearance' is from 65%, and mine is now 69%. Woohoo! He also said that if my 'clearance' reaches 75%, then my time would be shortened.
I am going to my next question and hope someone can explain succintly exactly what 'clearance' is.

well i guess to each his/her own but sayng 65% clearance is good wouldnt pass in nz
but then the dialysis service here dosent have to push 3 hour session paitents out the door to make enormous profits
me i will stick to my five hours i know that i feel a hell of alot better than i do on a four session not only during the session but for the rest of the day - a marked differance to the crappy feeling a lot of you seem to be saying you experience

on the matter of thirst - i tried ice didnt like it! - tried freezing orange juice but ittasted awfull so what i do now is severly restrict fluid drinking and put manderin segments or grapes in the fridge and use the as the main fluid intake - dont leave the in the fridge more than 36 hours because they loose their taste.

"O in" do you have any kidney function left? I was just curious because if you have some kidney function left that would help in you feeling better than others. But anyway here are some numbers for you.

A Normal kidney equals 168 hours of continuous blood cleansing in a 7 day week. If a person is on the machine for 3 hours 3 times a week then that person will have an equivalent of 5% of healthy kidneys if the same person increases his/her time to 5 hours 3 times a week he or she is getting just 9% of healthy kidney function. Bottom line is anyway you look at it we are doomed. The urea floating around in our bodies is causing way more damage that will cause other complications. Not to mention the excess calcium and phosphorus floating around clogging arteries, or the excess fluids enlarging our heart.

I say if you feel well with 3 hours as do I (I have zero kidney function) then that's all I need. But and extra hour on dialysis per treatment won't make a difference in the long run. If it makes you feel better to stay longer so be it however I hope you do not do it (stay 5 hours) thinking it will prolong you life. Because at the end of the day you or I won't die because of Kidney failure or dialysis we will die from complications of kidney failure.

[O in]

Well my nephrologist said that my 'clearance' has improved. He said that good 'clearance' is from 65%, and mine is now 69%. Woohoo! He also said that if my 'clearance' reaches 75%, then my time would be shortened.
I am going to my next question and hope someone can explain succintly exactly what 'clearance' is.

well i guess to each his/her own but sayng 65% clearance is good wouldnt pass in nz
but then the dialysis service here dosent have to push 3 hour session paitents out the door to make enormous profits
me i will stick to my five hours i know that i feel a hell of alot better than i do on a four session not only during the session but for the rest of the day - a marked differance to the crappy feeling a lot of you seem to be saying you experience

on the matter of thirst - i tried ice didnt like it! - tried freezing orange juice but ittasted awfull so what i do now is severly restrict fluid drinking and put manderin segments or grapes in the fridge and use the as the main fluid intake - dont leave the in the fridge more than 36 hours because they loose their taste.

"O in" do you have any kidney function left? I was just curious because if you have some kidney function left that would help in you feeling better than others. But anyway here are some numbers for you.

A Normal kidney equals 168 hours of continuous blood cleansing in a 7 day week. If a person is on the machine for 3 hours 3 times a week then that person will have an equivalent of 5% of healthy kidneys if the same person increases his/her time to 5 hours 3 times a week he or she is getting just 9% of healthy kidney function. Bottom line is anyway you look at it we are doomed. The urea floating around in our bodies is causing way more damage that will cause other complications. Not to mention the excess calcium and phosphorus floating around clogging arteries, or the excess fluids enlarging our heart.

I say if you feel well with 3 hours as do I (I have zero kidney function) then that's all I need. But and extra hour on dialysis per treatment won't make a difference in the long run. If it makes you feel better to stay longer so be it however I hope you do not do it (stay 5 hours) thinking it will prolong you life. Because at the end of the day you or I won't die because of Kidney failure or dialysis we will die from complications of kidney failure.

NO

do you think i am stupid or somthing i dont need a lecture from you about toxin clerance and session times and besides after three interventions i know im going to die of heart failure long b4 failed kinney complitations kick in

[Epoman]

Well my nephrologist said that my 'clearance' has improved. He said that good 'clearance' is from 65%, and mine is now 69%. Woohoo! He also said that if my 'clearance' reaches 75%, then my time would be shortened.
I am going to my next question and hope someone can explain succintly exactly what 'clearance' is.

well i guess to each his/her own but sayng 65% clearance is good wouldnt pass in nz
but then the dialysis service here dosent have to push 3 hour session paitents out the door to make enormous profits
me i will stick to my five hours i know that i feel a hell of alot better than i do on a four session not only during the session but for the rest of the day - a marked differance to the crappy feeling a lot of you seem to be saying you experience

on the matter of thirst - i tried ice didnt like it! - tried freezing orange juice but ittasted awfull so what i do now is severly restrict fluid drinking and put manderin segments or grapes in the fridge and use the as the main fluid intake - dont leave the in the fridge more than 36 hours because they loose their taste.

"O in" do you have any kidney function left? I was just curious because if you have some kidney function left that would help in you feeling better than others. But anyway here are some numbers for you.

A Normal kidney equals 168 hours of continuous blood cleansing in a 7 day week. If a person is on the machine for 3 hours 3 times a week then that person will have an equivalent of 5% of healthy kidneys if the same person increases his/her time to 5 hours 3 times a week he or she is getting just 9% of healthy kidney function. Bottom line is anyway you look at it we are doomed. The urea floating around in our bodies is causing way more damage that will cause other complications. Not to mention the excess calcium and phosphorus floating around clogging arteries, or the excess fluids enlarging our heart.

I say if you feel well with 3 hours as do I (I have zero kidney function) then that's all I need. But and extra hour on dialysis per treatment won't make a difference in the long run. If it makes you feel better to stay longer so be it however I hope you do not do it (stay 5 hours) thinking it will prolong you life. Because at the end of the day you or I won't die because of Kidney failure or dialysis we will die from complications of kidney failure.

NO

do you think i am stupid or somthing i dont need a lecture from you about toxin clerance and session times and besides after three interventions i know im going to die of heart failure long b4 failed kinney complitations kick in

Whoa calm down I never insinuated that you were stupid and I was not lecturing you I was simply throwing out some numbers. My post was not just for your eyes it was also information for anyone that reads this post.

Out of curiosity what part of my post offended you?

[Bear]

Um...
   we all know WHY the standard of 3 x 4 or 3 x 5 hours per week
dx exists around the world, don't we?
  ...in case NOT ,it's because U.S. Congress ,after consulting with the
 'expert advisors' they had then, decreed that _that_ was enough to
'sustain life' and therefore all they'd pay for on Medicare, or whatever
...back in 1972.
  A quote from the Victorian Senior Neph., who pioneered nocturnal
dx in Oz, after a cost-effectiveness study on Renal Medicine, -
"There's nothing I can't get off you in 8 hours dialysis per night!"
-admittedly he was talking about 5 or 6 nights a week.
  The longer the dialysis, the more the clearance. SO Epoman gives
the equivalent %age versus 'real' kidney function, but then 'shoots
himself in the foot' by saying he'll do less as long as he feels better.
ER....where's the logic there???
  Plus the longer you're on the easier & less stressful the UF fluid loss.
  I know it's a pain-in-the-arse staying on long times. I've done 7 once,
when I totally failed to cannulate for a Sunday evening 4 hour sesh.,
so 'made up' for it on the Tues with 7. Like Mel, I hope to do 3 x 8,
plus maybe a short one still on Sun evenings when on nocturnal -
 no problem with boredom if you _can_get some sleep (!?) - but
even I have been guilty of cutting the odd session short(er) if things
arise, like appointments or social stuff.
  But I don't make a habit of it!
  O.K. boys...put those boxing gloves away!! 
 

[Epoman]

Um...
   we all know WHY the standard of 3 x 4 or 3 x 5 hours per week
dx exists around the world, don't we?
  ...in case NOT ,it's because U.S. Congress ,after consulting with the
 'expert advisors' they had then, decreed that _that_ was enough to
'sustain life' and therefore all they'd pay for on Medicare, or whatever
...back in 1972.
  A quote from the Victorian Senior Neph., who pioneered nocturnal
dx in Oz, after a cost-effectiveness study on Renal Medicine, -
"There's nothing I can't get off you in 8 hours dialysis per night!"
-admittedly he was talking about 5 or 6 nights a week.
  The longer the dialysis, the more the clearance. SO Epoman gives
the equivalent %age versus 'real' kidney function, but then 'shoots
himself in the foot' by saying he'll do less as long as he feels better.
ER....where's the logic there???
  Plus the longer you're on the easier & less stressful the UF fluid loss.
  I know it's a pain-in-the-arse staying on long times. I've done 7 once,
when I totally failed to cannulate for a Sunday evening 4 hour sesh.,
so 'made up' for it on the Tues with 7. Like Mel, I hope to do 3 x 8,
plus maybe a short one still on Sun evenings when on nocturnal -
 no problem with boredom if you _can_get some sleep (!?) - but
even I have been guilty of cutting the odd session short(er) if things
arise, like appointments or social stuff.
  But I don't make a habit of it!
  O.K. boys...put those boxing gloves away!! 
 

I didn't shoot myself in the foot  I said I only run 3 hours and that's what I prefer. I have run 4 hours and my labs were no better than when I ran 3 the difference though was that I felt really bad after 4 hours on the machine. So if the labs were no better (well except for a very little increase in kt/v) running 4 than 3 why would I do 4 if I felt like crap afterwards.

[kevno]

With my lab results I should be on for 5hours but the unit only allows you to do 4 hours.  My pump speeds are bad.  200 - 250 only. My urrs are 62% this month, the unit aims for 70%+

Kevno

[Bear]

I'm surprised your figures are no better on the longer dx sessions Epo', mate 
...and also that you feel crappier after the longer sessions.
   Surely the lower the UF rate the better you feel afterward. I know for me
there's a huge difference between taking off, say 400 an hour and 600 an hour!
    Different molecules come off at different rates too...I think it's the larger ones that
are later - but there'll be more experts on here who can verify that - so the shorter
the session the less chance  you are giving some things to get dialyzed out !?
    3 x 5/4/3.5 dialysis is purely a matter of $$$/unit time/wages and NOT based upon
the optimum health outcomes of the patient, let's be honest.
    Fortunately for me, I seem to be in the hands of a unit with a flipped ethos, in that
regard. But I suspect they're few & far between.....the reality for the in-hospital dx-ers
however, is still the old 3 x 5 here.

[Epoman]

I'm surprised your figures are no better on the longer dx sessions Epo', mate 
...and also that you feel crappier after the longer sessions.
   Surely the lower the UF rate the better you feel afterward. I know for me
there's a huge difference between taking off, say 400 an hour and 600 an hour!
    Different molecules come off at different rates too...I think it's the larger ones that
are later - but there'll be more experts on here who can verify that - so the shorter
the session the less chance  you are giving some things to get dialyzed out !?
    3 x 5/4/3.5 dialysis is purely a matter of $$$/unit time/wages and NOT based upon
the optimum health outcomes of the patient, let's be honest.
    Fortunately for me, I seem to be in the hands of a unit with a flipped ethos, in that
regard. But I suspect they're few & far between.....the reality for the in-hospital dx-ers
however, is still the old 3 x 5 here.

My Kt/V was just slightly higher for example instead of the usual 1.3 it was 1.4 and regardless of the rate of removal (I have a very high tolerance of fluid removal I can remove 8 pounds in 3 hours no problem) I still felt weaker and more tired. Remember the longer your on, the more "good" stuff that is removed as well.

[Bear]

"..the longer your on, the more "good" stuff that is removed as well."
- which is why some of the nocturnal patients end up requiring additives,
even phopshate!!

[Epoman]

"..the longer your on, the more "good" stuff that is removed as well."
- which is why some of the nocturnal patients end up requiring additives,
even phopshate!!

Yeap, Lucky them  I would just get a bunch of Chocolate.  to help get more phosphorus.

[Tracy Lynn]

Right now I'm on four days a week- three four hour sessions and one three hour session. I've only been doing it for two or three weeks. The first week was ok, but over the last week or so, I have just felt sicker after each treatment.

Today I was at the unit for five hours instead of four, because my pressure kept dropping, and I couldn't leave until it stabilised.

The techs are really nice, and go out of their way to make things better for me (one bought me ginger ale from the machine today when I got nauseous ), but by the time I got home, I was a wreck.

I've been a mess all day and I had to cancel appointments. I did the errands, but only because I had no groceries and no phone (phone broke on Tuesday). 

I've been sick to my stomach all day, and dizzy off and on. I feel like ass. My clearance rates were not very good, which is why I had to do more, and there isn't room right now on the overnights.

I'm just tired of feeling sick all the time.

[Hawkeye]

My pump speeds are bad.  200 - 250 only.
Kevno

If you don't mind me asking, do you have a cath?  Any other type of access and even a newer cath should be able to handle much higher pump rates.  Unless it's uncomfortable for you to go higher I would talk to your doc about that.  A lot of the old school nurses and even some docs that have been around awhile still think that all caths have to be at lower speeds, and train new people in this same manner.  This is no longer true and hasn't been for quite some time.

[kevno]

Hawkeye,

I have these lines in since Oct 2003, Called Tescio Lines. Never had much over 250 pump speed, today pump speed 250. Pressure 220. It is just the way it is for me, even if I have one needle the pump speed. Still 250 with a high pressure going back through the cath. I now a lot of patients with these tescio lines and can get speeds of 350+. With good pressures.

The doctors know it is because my veins are damaged. I have everything done to try to make the flow better, an geograms to clean the lines out. No difference. This is my third set of tesico lines I have had in. All the same. Plus the fistula is as good as it is going to get. I had it done 1980. Lost most of it 2001. Only a 2inch stretch can be used. Also had Fistula grams done. To many needles in my arms. Plus the doctors can not touch my legs because of the vasc damage.

Kevno

[Hawkeye]

The doctors know it is because my veins are damaged. I have everything done to try to make the flow better, an geograms to clean the lines out. No difference. This is my third set of tesico lines I have had in. All the same. Plus the fistula is as good as it is going to get. I had it done 1980. Lost most of it 2001. Only a 2inch stretch can be used. Also had Fistula grams done. To many needles in my arms. Plus the doctors can not touch my legs because of the vasc damage.

Kevno

Sounds like you have tried it all and then some.  I can't offer any advice beyond what I left in my last post, and that doesn't do anything for your situation.

[jasperkat]

My husband just had his session increased by 15 minutes - to 3.5 hours as a result of my concern about his lack of appetite and fatigue.  I was just interested in how long you are in the clinic.  His labs aside from Albumin are good and that is 3.0.  His fatigue is worse on Monday before he goes to dialysis.  Thanks for your input!!




EDITED: Merged threads, same topic - Sluff/ Admin

[jbeany]

Everyone at my clinic starts at 4 hours.  They dropped my time by 12 minutes, so I'm now on 3 hours and 48 minutes.  The doc has suggested that my URR is good enough to drop some more time off, but I'd rather not.  It's working now, so why mess with it?

[stauffenberg]

Generally, in countries with socialized medicine, where there is no profit motive in treating dialysis patients, the treatment time for hemodialysis is at least four hours three times a week, since this considerably improves survival time for patients.  I eventually had a time of four and a half hours, but there were some patients doing five or even six hours per session.  Even with these longer times, however, the rapid aging and accelerated rate of physical decay were palpable.