slowly cutting back on dialysis, is it normal?

[sullidog]

I have been on dialysis since May and they have been slowley been pulling 15 minutes at a time off of dialysis. They say it's because my labs have been looking so good and the adiquicy of dialysis I've been getting has been really good even though they've been pulling the time off. My creatnine is the only thing that is usually high in my labs and they consider the rating of it acceptable. I can still urinate like a normal person in fact I don't have fluid retention and at one point they didn't even have a dry wait for me. They put me at a dry wait a few months ago even though there's no fluid profile for me because they don't need to take anything off. They have never done a clearence test on me but I'd like them to do one.
So is it normal for someones dialysis time to be slowly cut back? Also is there such thing as too much dialysis?
Troy

[Joe Paul]

The blood tests usually tell the tale. Up to my 3rd year on dialysis, I too peed like any "normal" person out there, but, my labs told me my kidneys were slowly dying off. I don't believe there is "too much dialysis", so long as they aren't taking too much fluid, and making your BP crash. It sounds to me, you may be able to prolong your kidney function by diet, I would  question both your Neph and dietitian to see what options you have.

[Bill Peckham]

I'd want a 24 hour urinalysis. And I'd consider seeking a second opinion.

It may very well be that you need dialysis, like Joe Paul, but Maker's experience says you need to check.

[jbeany]

It's common practice for centers to start everyone at the same amount of time - my center started everyone on 4 hour runs.   Once you have been on, and you get urea clearances that are consistently above the goals set by Medicare, they usually start knocking time off in 12 or 15 minute increments, then seeing when your clearances are after the next month.  Medicare requires that the vast majority of patients in a center be above 65% clearance in order for the center to get full reimbursement.  So as long as your clearance is above that level, they will usually knock down your time until you reach close to 65%.  it's cheaper for them, and they clear out the chair faster, too.

This is not necessarily a good thing for the patient, however.  65% is certainly enough to keep you alive.  It's not anywhere near what dialysis is capable of doing, and it's certainly not enough to keep most patients feeling good.  The short term gain of  less time in the chair can leave you feeling crappy the other 20 some hours of the day when you aren't in the chair, and make you feel bad on the days you aren't even at dialysis.  My center suggested I cut my time.  I was running between 82 and 85% clearance.  I refused, and actually got permission to increase my pump speed so that I was getting even more treatment during the 4 hours I was there.  I felt better, and got rid of the crappy metallic taste in my mouth.  (Urea clearances don't give a very good picture of how well dialysis is really working anyhow, but that's a whole other post. . .)

This is, of course, something that varies from patient to patient.  Many patients are so uncomfortable in the center, stuck in the chair, that it is both a physical and mental challenge to stay there for any amount of time.  15 minutes less is a huge bonus for them.  If you, like me, don't think the small gain in time is worth the health difference, make it clear to them that you don't want your time cut.  They may pass out from shock to hear a patient ask for more time, but they should agree if you stand your ground.

[2_DallasCowboys]

Hi,

Please insist on a 24 hr urine/blood test.  Everyone is different, and so much
pertains as to why your kidneys failed.  Also, this will let Drs. know how much
function you have, and   -   it  is your body, I would ASK (nicely, of course  )
that they do this for you.

My hubby's kidneys failed after he had triple bypass heart surgery - and I have
never gotten a straight answer as to why they failed.  I would want to know
why they are reducing your time, have them go over all of your blood #'s with
you, and then insist on a 24 hr urine to see how much creatnine your body
os getting rid of in that urine.

Let us know how you do!

Anne