Is it possible to over dialyse?

[flipperfun]

Again yesterday I was told that my blood results show I am over dialysing.  My KTV is 2.4 and URR 90%.  The suggestion (again) was to dialyse twice a week not the current 3 times a week.  It's freaking me out.

I have said no to twice a week as I'm already having a hard time keeping my fluid intake at the current levels, and my blood pressure is constantly up and down as they reduce/increase my dry weight.

I thought the higher the numbers the better.  I understand the unit aims for an average KTV of 1.7, so why would they want to reduce my rates downwards?  Is it dangerous to have a high clearance rate?

Any thoughts would be most welcome.

Thanks

[Rerun]

This has happened to me too and I have 0 kidney function.  The bottom line is Medicare will start to question the high numbers.  Heaven forbid Medicare starts poking their nose around.  So what they did for me is give me a "Less" productive dialyzer or artificial kidney.  Can you believe that?

Do they not want us to feel better?  Isn't it the goal to do well?

Do well ..... but not too well!   

[noahvale]

^

[Rerun]

Because even extended hour nocturnal shifts usually have lower KT/v's because people cheat and eat more of what they want.   They don't exceed what Medicare has for a number.  I AM on Nocturnal 8 hours 3x a week and they reduced my dialyzer and said I would not notice anything.  And I didn't notice anything but what would I feel if they used the good dialyzer?

Just my opinion.

[Riki]

I've never heard of that.. but then again, my medical system is not profit based..

[noahvale]

*

[amanda100wilson]

that isn't a high Kt/v, plenty of people doing extended using NxStage have higher.  not sure about the URR though..

[geoffcamp]

Quick question are you still producing urine or do you sweat from work outs or work if your working??

[Whamo]

Yes!  If they take out too much fluid you cramp.  The worst is when it happens as your drive home from hemo.  It gets you in the gut.  I thought I was going to die.  I paid a homeless guy $10 to buy me water, and I looked so bad he brought two of them for me.  I was fine, after 1/2 hour, after drinking it down, but what a nightmare that was.

[Desert Dancer]

My kt/v is usually around 4.0 and my URR about 90; no one's ever indicated to me that's a problem, Medicare-wise or otherwise. Someone at your unit is full of it and I'd ask them to produce the regulation.

[sullidog]

I remember when I had those great numbers on dialysis, the only thing they did was cut my time back until I told them that cutting back was becoming unacceptable do to the way I was feeling and they left me alone.

[amanda100wilson]

 Desertdancer, you express it so eloquently and I agree with you completely.

[noahvale]

^

[noahvale]

^

[Zach]

Again yesterday I was told that my blood results show I am over dialysing.  My KTV is 2.4 and URR 90%.  The suggestion (again) was to dialyse twice a week not the current 3 times a week.  It's freaking me out.

It's also possible that the post-bloods were drawn incorrectly.
They must always be drawn from the arterial (red) blood port.  Never the venous (blue).

[flipperfun]

Thanks for the responses everyone.

Noahvale - "It would be helpful for you to include your physical condition and co-diseases so posters have a better idea about your situation as you did in a  comparable thread over a year ago (http://ihatedialysis.com/forum/index.php?topic=23908.msg386549#msg386549).

On your previous post, Hemodoc suggested that you go to Home Dialysis Central (http://forums.homedialysis.org/forumdisplay.php/16-Dr.-John-Agar-Nephrologist) and give Dr. Agar pertinent info about your condition, and then take his response/suggestions to your nephrologist.  Did you follow through?"

I kind of lost the threads to my last post (not used to this forum) I do not recall contacting Dr Agar.  But will look again at what Hemodoc suggested.

I am very small (child age 8 and weigh 29 Kgs) due to childhood rheumatoid arthritis, (stills disease in children) hence never growing to normal size.  I also have Bronchiestasis as well as renal failure due to Amyloidosis.  I have always been prone to chest infections and have had pneumonia a few times.  My ability to walk is now severely restricted, due to long term arthritis, and I use a manual wheelchair indoors.  Because of my small size any dry weight alterations are around 0.2 Kgs at a time as I cannot tolerate more in one session.  My average weight increase between sessions is 0.9 Kgs.

I am just concerned that the same issue has raised it's head again, less dialysis.  In the UK it seems that the aim is to achieve 1.7 KTV.  I really do not know how it would benefit me to have dialysis twice a week, other than more freedom.  I am not on the transplant list because of the various other medical problems that I have, and so I simply need to stay as well as I can for as long as I can.

Thank you again for your responses.

[flipperfun]

Some additional information, I dialyse for 3 hours, 3 times a week and have been on HD for 5 years.  I figure that means my weekly amount of dialysis of 9 hours works, so why reduce it to 2 sessions per week?  I will talk to my consultant soon.

Thanks everyone.

[Rerun]

Again yesterday I was told that my blood results show I am over dialysing.  My KTV is 2.4 and URR 90%.  The suggestion (again) was to dialyse twice a week not the current 3 times a week.  It's freaking me out.

It's also possible that the post-bloods were drawn incorrectly.
They must always be drawn from the arterial (red) blood port.  Never the venous (blue).

Good point Zach...

[lmunchkin]

Again yesterday I was told that my blood results show I am over dialysing.  My KTV is 2.4 and URR 90%.  The suggestion (again) was to dialyse twice a week not the current 3 times a week.  It's freaking me out.

It's also possible that the post-bloods were drawn incorrectly.
They must always be drawn from the arterial (red) blood port.  Never the venous (blue).

Good point Zach...

You beat me to it Rerun!!!!

[amanda100wilson]

even the guy who came up with Kt/v now accepts that is a poor measure of adequacy as it only measures clearance of certain solutes, urea, I think.  there are plenty more toxins that need to be removed.  three times a week HD approximates to about 10% of kidney function, so cut it back and that percentage will drop.  sounds to me that they need to find other ways to control your  low BP such as not pulling off fluid too quickly, making sure that your dry weight hasn't changed.  what is your sodium level?  if this is low, increasing your salt intake can also help.