Question about Clearance if anyone Knows???

[Bub]

I run 4 1/2 hours with a blood flow of 450 (unsure of units).  My clearance has been 1.5 (1.4 is the goal). Not good enough to reduce my time.  The clearance results apparently are not related directly to potassium or phosphorus. 

My goal is less time on the machine.  450 is the fastest they will go on blood flow.  Is there anything I can do, say in my diet or any other method, to improve clearance.  I see so many people on for just 3 1/2 hours and I am so jealous.

Can I get so input from some of the more veteran IHD members please?

[RichardMEL]

My understanding.

Clearance, or URR (Urea Reduction Ratio) is all about how efficiently the dialysis is clearing the toxins out - obviously the higher the better, and if you have a high clearance then you *could* in theory, do OK with less time on the machine, though that would lower your clearance. I know I got to an 82% clearance and they still wouldn't lower my time (you think 4.5 hours is bad, some of us are on 5) so I'm not sure what measure is used for that kind of thing (Zach is the guru on these sorts of things). I understand an adequate "minimum" acceptable clearance is around 65%.

re time on the machine you also have to remember it relates to body weight - most women, being lighter, tend to need less time on the machine. There's a old man in my unit who weighs about 50kg (!) and he only does 4 hours because of this.

The point being that some of those 3.5 hour folks may be much lighter/smaller and this require less time and have nothing to do with the clearance per se.

[kitkatz]

As I see it the longer on dialysis the better for you. I am on for eight hours and have a clearance of 2.7 to 3.0.  I also feel better overall thatn I did with a clearance near 1.4.

[nursewratchet]

Longer is of course better.  This being said from someone not on dialysis.  Goal is at least 70%, or 1.4 MINIMUM clearance.  Other things that can increase clearance are: bigger needles, Blood flow rates, but you said you are maxed out.  Get rid of a catheter if you have one.  A bigger dialyzer, as each one has a "Coeffiency rating", bigger will be more efficient.  Ask what size dialyzer you are on, and if you could go up.  Could also ask for more,but shorter times.  Hope that helps...

[Inara]

More information, please. 

Are you dialyzing via catheter/fistula/graft?  Is it clinic policy to not run patients above 450?  What size dialyzer are you on?  Reuse?  Needle size?

[Inara]

Oh, and, is nocturnal an option? 

[Ang]

more  time  is  definetly  beneficial,i  do  4.5  would  love  4  or  even  3.5 but  in  time  my  labs  would  be  crap  and  have  to  move  to  5 hours  probably so  i  stay  where  i  am  and  put  up  with  it,my  u.r.r  is  about 72% which  i'm  told  is  ok

[RichardMEL]

Absolutely more is better. That's what I tell myself when the others on less time finish up and leave - "no pain, no gain" as the saying goes. I believe it will assist me greatly in the long run to be in the best shape I can be in for when the call comes.

[Bub]

I am embarassed by how little information I actually have to provide.  I am currently using a fistula.  It is policy to not excee 450 although that rule is on occasion broken.  Not sure what size needles or dializer I use.  I do feel good running 4 and 1/2 hours but, I Hate Dialysis.

[KICKSTART]

Im not sure about clearance , but we have what seems to be a standard policy over here . Everyone does a standard 4 hours , the only exception being some one who is small or light !

[Goofy]

RichardMel, I didn't realize you are on dialysis for 5 hours at a crack.  How do you deal with it?  I'm going to do PD (some day!) because there no way I could sit in a chair for an hour, let alone 5! 

I suppose you just have to learn to deal with it, but seriously, at this point, I really don't think I could do 5 hours.  You always have such a positive outlook!  I guess it likes when my kids were in school.  I used to tell them you HAVE to go so you might as well enjoy it.

I'm the kind of person who always tries to get people to see the positive things but somehow I don't listen to myself.

[Wallyz]

Bub- I know this isn't what you want to hear, but you need to learn to deal with more time on dialysis.  A 1.4 is minimal, but it will kill you slowly.  More time, get on an nocturnal program, get home.

[RichardMEL]

RichardMel, I didn't realize you are on dialysis for 5 hours at a crack.  How do you deal with it?  I'm going to do PD (some day!) because there no way I could sit in a chair for an hour, let alone 5! 

I suppose you just have to learn to deal with it, but seriously, at this point, I really don't think I could do 5 hours.  You always have such a positive outlook!  I guess it likes when my kids were in school.  I used to tell them you HAVE to go so you might as well enjoy it.

I'm the kind of person who always tries to get people to see the positive things but somehow I don't listen to myself.

Goofy not really the right topic for this (but when did this ever stop us?? lol)... yeah look 5 hours for sure sometimes it's an exquisite form of torture.. other times it is OK. I find ways to amuse myself - usually involving ipod or watching stuff on my laptop - that helps the time fly. Talk to the staff etc. Today for example was the big football Grand Final and the whole unit was pretty excited watching, so we all got into that and had a bit of fun (Saturday's are usually more relaxed ) and the time went fairly quickly (well...)

PD isn't an option for me so hemo it is. It's OK. In a way I don't mind being in the unit - it's quite social in a way. We see the friendly staff who are a bit of a community and share stuff, chat etc.... Home Nocturnal would be the best for me, but I can't do that either so... hey like you said you just have to put up with it in the end because the other option isn't very good. I figure being positive is better for me than curling up in a ball and being depressed and most of the time I do OK at being positive.

[Goofy]

Since this is off topic, I'll keep it short..........well, I give you a lot of credit for having such a positive attitude.  I guess part of it is the center you're at. 

Look at poor Kickstart and all the nonsense she had to put up with when she first started going to her center. Now it seems since she's changed shifts, her outlook seems more upbeat!

I guess we have to learn to make the best of a not so good situation!

[KICKSTART]

 

[kidneydoc]

As mentioned before more time on dialysis is better, hence why Nocturnal hemodialysis is so good for you. Phosphate levels are one of the major indicators of heart disease in dialysis. There is no good way to get rid of phosphate on dialysis except increasing the duration unfortunately. So increasing blood flow and decreasing time may increase your phosphate levels. The excretion of certain intermediate molecules not readily measurable by the formula that calculates urea clearance may also be affected negatively by decreasing time.

[Bub]

They have cranked the blood flow up a little and the neph seems satisfied with the clearance but unwilling to reduce my time.  The is only one center is my city offering nocturnal and I am reluctant to change centers (basically just afraid of change -- any change).  I am feeling great and guess I will just have to deal with it.  My phosphorus levels are very high so the neph simply can not reduce my time.  I am working on it but am not very comliant in taking my binders.  I just wish there was so way to pass the time instead of television.  In our center there is only one tv for every two chairs and and spent 4 and 1/2 hours one Saturday watching Teenage Mutant Ninja Turtles because that's what my neighbor wanted.  Heaven help me. What I need is a Valiun prescrption.  That would pass the time!

[RichardMEL]

They have cranked the blood flow up a little and the neph seems satisfied with the clearance but unwilling to reduce my time.  The is only one center is my city offering nocturnal and I am reluctant to change centers (basically just afraid of change -- any change).  I am feeling great and guess I will just have to deal with it.  My phosphorus levels are very high so the neph simply can not reduce my time.  I am working on it but am not very comliant in taking my binders.  I just wish there was so way to pass the time instead of television.  In our center there is only one tv for every two chairs and and spent 4 and 1/2 hours one Saturday watching Teenage Mutant Ninja Turtles because that's what my neighbor wanted.  Heaven help me. What I need is a Valiun prescrption.  That would pass the time!

lol bub! That's horrible!!!!

Can you not take a portable DVD player, mp3player/ipod or laptop in with you to amuse yourself with? Even a little radio? I do all of these things (well I use my laptop for a dvd player). That way you don't have to rely on what some other boob wants on the TV and can amuse yourself.

My other thought is that it is not fair that YOU had to allow the other person to get their whole way for 4.5 hours!!! I would have tried to ask for a compromise- like You get half of TMNT, and then we switch to something else that I'd like to watch. I know some patients can be very agressive and it's not worth trying or arguing but gee I'd like to think if it was me sitting with someone else having to share a TV(and I did not have my usual amusements) that I'd at least share the tv watching. Although i am more the sort that would probably let the other guy watch whatever and I would just endure for the sake of harmony! LOL

[Bub]

We have had so many arguments about the tv in our center, I refuse to argue over it.  I just give in to the other person.  I guess I am not very agressive.

I have complained to management and they basically told me which rope I could pee up to leave my sample.

[Bajanne]

My clearance has been doing much better, and I was trying to ask the nephrologist the bring down my time, but I have changed my mind about that.
We just had a patient from my shift who died.  They said that she had refused 4 hours and would only have 3, and yet did not restrict her fluids well enough.
I am going to stick with my 4 hours.  I have always been told that longer is better.  After all, our kidneys dialysed 24/7 when they were functioning!

[jbeany]

The only other suggestion I've got to increase clearance and get a shorter time is lose weight.  I dropped 50 pounds over 3 years, and kept my time the same with the intention of getting much better clearances.
Slightly off-topic here - you need to get something to keep you entertained.  I always had private tv, but at 6 am, there was rarely anything I wanted to watch.  I always had a bag with newspaper, mags, library books, an ipod, a hand held tetris game, sewing projects small enough to do in my lap, etc.  What about crosswords, suduko, seek n find puzzles, a laptop, a dvd player. 
start writing a daily letter to a politician, bring a cell phone to call friends.  Being bored makes it that much worse to sit in that chair.

[RichardMEL]

My latest clearance is only 75%

bummer !!!

Speaking of cell phone use there's a new patient in our unit and she spends I think 4 out of 5 hours on her phone!!! It doesn't bother me much but I don't know how someone can talk almost nonstop for 80% of asession! 

[aharris2]

They have cranked the blood flow up a little and the neph seems satisfied with the clearance but unwilling to reduce my time... My phosphorus levels are very high so the neph simply can not reduce my time.  I am working on it but am not very comliant in taking my binders.

Hi Bub, It is actually amazing how much difference that 1/2hr makes. My brother had his time reduced from 4 1/2 hrs to 4 hrs and he is much happier. Yes, more (dialysis) is better, but only if you can take it. RichardMel, at 5 hrs that is difficult yet you always seem to find a bright side. You're really quite something.

Okay Bub, here it is:
You want to know what to do to get your time reduced. You told us that your clearance had improved but that the neph won't reduce your time because of high phosphorus. You say that you are not very compliant with your binders.

Bub, be compliant with your binders!!! Your reward may be that reduction in dialysis time that you want! Get the neph to confirm that to help motivate you. Why the noncompliance? Perhaps the binder you use doesn't suit you. If not, there's plenty out there. Take charge, do what it takes to get that time reduced!