dialysis removes 65% of toxins?

[texasstyle]

Hello everyone. I was trying to look up in some of my old post replies but I am trying to remember if it was told to me that dialysis only removes 65% of the toxins and it is up to you to maintain the in between days. Am I correct with my memory? Thanks!

[tito]

I'm no expert on this, but I am inclined to say that the percentage really depends on the type of dialysis, the level of uremia you have, etc. For example, in my case, my BUN (blood nitrogen) went from 135 to about 75, then started to creep up again to 102. I do PD, so they recommended a daytime dwell (I'm a slow transporter), which has brought my BUN back to 60. Is BUN measured on a linear scale, or is it exponential (is a reduction from 135 to 60 a bit more than 50%?)

Normal BUN is about 30 tops, I think.

Of course, with PD, there is no "in-between" as it's done every day. I still try to watch potassium, I take phosphorous binders, and so I guess some of the reduction in toxins is up to me and not the dialysis. PD is more forgiving in that respect than hemo.

I'm just learning about all of this myself.

[jbeany]

Ah, no, dialysis, done right, can do much better than that.  I was running around 85%, by insisting on staying at a 4 hour run when they said I could lower my time, and by pushing for a higher pump speed so I got the best possible clearance during that 4 hours.  If you are lucky, you can get your center to get a better, bigger filter, too.  ( I never had any luck with that, since my results were already good.)

65% is the number the clinics are required to achieve in order to get reimbursed properly by Medicare.  I'm not sure of the exact percentage of patients who must have at least that function or better, but there are all kinds of problems with getting paid if they don't accomplish the 65%.  A lousy clinic will keep its patients at the bare minimum of care needed to get to the 65%.  A good one wants the patients to do better so they feel better.

[RichardMEL]

yep the 65% is the "adequate" clearance level suggested for good dialysis. My last measure I was at 75% but have been as high as 82%. A bigger dialyzer, and longer dialysis will mean more toxins are removed (as jbeany says). I'm talking about hemo - not sure about PD figures.

Of course this figure will also vary depending on diet, exercise and so on which can relase more toxins into the blood. For example I imagine if you sat on your butt and didn't eat much you could probably get a decent clearance.....

[texasstyle]

Thanks for the replies. As you know my husband is on 2x a week and does not take good care in between. His nurse called this morning to get him to go into tomorrow for holiday reschedule dialysis instead of Sat. He goes Mon & Fri normally. She asked me on the phone is he still sleeping/vomiting as much as you said and I told her yes. He slept for HOURS yesterday about 12 and it wasn't even dialysis day. She said she was just speaking to his Dr. and he denies this. I hate the fact of 3x a week but it would definitely be better quality of life. I hope they decide to start this finally.