Should I go from 2x a week HD to 3x a week?

[Frank1931]

Hi Folks,
My dad started HD in October 2013.  The Dr said he wanted to send him 1x per week to take the load off his kidney.  When it was time to start, he changed that to 2 x a week.  They are now changing that to 3x a week but I  really question the logic.  He actually has gone 3x for the last two weeks and would like to go back to 2x.  He know feels crappy 3x a week instead of 2.    All his blood values were fine or normal at 2x.  His weight at pre and post is almost the same 2 or 3x.  In full disclosure, he is .40 kg heavier pre at 2x. That is about the increase in fluid they are removing, at 3x also.    They are removing 3.98 liters @ 2x and 3.48 @3x.  It does not seem worth it!!!  Not to mention, he presently urinating about 5 liters a week. 

That is my biggest concern, I do not want to lose that kidney function.  His last urine output test was 24 ounces in a 24 hour period.  Any thoughts.....looking for some guidance. 

I interrogated the Dr and I am absolutely concerned about the lack of knowledge regarding his values and the reasoning behind the change.  I had to correct his in regards to my fathers URR and pre weight.  The main reason they went from 2x to 3x is they thought he had fluid pooling in his leg but is was Gout. 

Don't get me wrong, I believe the Nephrologist did an exceptional job prior to dialysis.  However, he is also the director of the dialysis center and is either over his head or just letting the machine do the work 

Last values:
Potassium 4.0
Calcium 6.2
Phosphorus 3.2
URR 73
Kt/v1.57

Thanks in Advance,
Frank 1931

[cassandra]

Hi Frank, I'm no doctor, but have been doing RRT since '83, and if your dad's bloods are okay with 2 days, I'd go back to 2.

Wishing you and your dad well, and strength

Love, Cas

[RichardMEL]

I'm in two minds on this one.

The general idea I've heard from multiple nephs in this part of the world is that once D has started the kidneys can get "lazy" because they are being propd up, so if anything you'd want to hold off dialysis as long as possible to begin with - but that's no longer an option. This would suggest staying at 2x/week. However, since D has begin it is possible that in the medium term the remaining kidney function will still fall, and 2x/week will not be enough. Those values look OK to me (though we use a different scale for Ca for example, so I have no idea if that value is within a normal range or not). It does seem that the key here is fluid - and he's outputting quite a lot still - is he on any kind of intake restrictions yet or not? It is fairly common once dialysis has begun for urine output to drop drastically and in time stop fully - and that is when more regular D is needed - because the urine output is also helping to remove what toxins the remaining kidney function is removing, and the fluid is not building up (or hopefully not much) around the lungs or heart etc.

Is it possible to get a 2nd opinion from a neph? Why has the original one recommending (or started) 3x/week treatments?

I'd also say one set of  lab figures is not enough of a data point to go on. I'd be wanting to see 3+ to establish some kind of trend - stable, up, down, whatever to help decide.

Perhaps a compromise on time may also be acceptable - 2x/week for a longer time on D, vs 3x/week less

good luck

[Frank1931]

Thank you four your response.  The values all fall in the good or normal range.   I didntrend these out over 3 months and they are all in the good/normal range. He really is not on any fluid or diet restrictions but we found 36-40oz (1 liter) of fluid to be the sweet spot for him. 

I made an appointment for a 2nd opinion.  They went to 3x because they believed he was retianing fluids in one leg but it was gout as I explained to them. 

Thank you again for your insight and guidance.

[CalamityEC]

In this case I'd definitely support getting a second opinion.  I did 3x a week and didn't find my urine output changed.  I peed a little less than when my kidney was functioning better, but I didn't retain any water.  best of luck too you and your father