why does it have to be three times a week?

[charlie boy]

I have been on hd for eight weeks and my fistula has blown several times. This has meant missing sessions for a week or even more while it heals. During these times I have felt OK and have not become breathless or gained weight (no fluid retention). I still pass about two litres of urine in 24 hours. I asked my dialysis doctor if I could reduce to twice a week, to encourage my kidneys to keep going a little longer, especially as dialysis gradually reduces the kidney function any way. But he says everyone is on three times a week and it has proved to be the best amount. Surely it would be better to encourage your kidneys to continue to work, and I would be able to drink a normal amount of fluid for a little bit longer. My potassium and phosphate levels are good. Does any one know if twice a week is ever allowed? It feels like they treat you all by a standard without looking at the individual.

[Sugarlump]

When i first started dialysis i only did twice a week for about 5/6 months and resisted all pressure to change or lengthen my sessions from 3 to 4 hours.
My bloods were fine, i was still passing urine and i felt fine.
remember you are in charge of your own treatment and doing twice a week, especially if you fistula keeps blowing (why?) would be better for fistula.
Argue your case with your doc again.
One size does not fit all 

[cdwbrooklyn]

You know your body better than anyone else.  When it comes to making a change in my treatment, I will ask my doctor if I can try it for at least one month and see if it works and my results are good.  If things work well, I will convince my doctor to let me stay doing what I'm doing and if things happen to change, I will go back to my original schedule.  So if you feel you can do well off of two treatments a week, go for it.   Also, just a suggestion,  if you cannot to two treatments a week, you can see if you can reduce your time to 2 1/2 or 3 hours 3x week.

[Stu]

I've often wondered this....

How can 4 hours x 3 times a week for me, an active 44 year old 97kg man, be the same "ideal" treatment as for an 85 year old 45kg woman

Something smells wrong with that

[Simon Dog]

I've often wondered this....

How can 4 hours x 3 times a week for me, an active 44 year old 97kg man, be the same "ideal" treatment as for an 85 year old 45kg woman

Something smells wrong with that

The typical approach to dosage adjustment is to vary the filter size (160/180/200/250) and time on the machine rather than number of days.   I doubt you have the same filter and on time as an 85yr/45kg female.    In general with dialysis, the more frequent the better (though there is some concern for patients with remaining residual function), so it's less common to go below 3x/week.   3x/week is a compromise for expediency - every other day would be better but the cost thing gets in the way.

[Sugarlump]

Changing from 3x a week for 4 hours
to
4x a week for 3 hours has made a big increase to my well being.

[Riki]

I don't think I could do less than 3 times a week... I'd like to have it every other day, as on the 2 day break (the weekend) I tend to really start feeling crappy by Sunday afternoon...

[Sugarlump]

Yes, me too.
As we now on home dialysis we normally do Mon,Tues, Thursday & Saturday (thus no weekend as such)
Stops that awful Sunday afternoon/Monday morning bloated and tired feeling

[charlie boy]

That's the whole point. I didn't feel ill before I went on dialysis. My appetite wasn't as good, and I got itching from the phosphate but it wasn't too bad. Now the Doctors say 'Oh you must feel so much better' and then they are surprised when I say it isn't much different. After the weekend break I still feel fine and haven't put on weight or got breathless, so I think my kidney function is still doing reasonably even though it is down to 7. My potassium is under 5 before dialysis and my phosphate is about 1.7. I am not in denial and know that eventually the urine will lessen and I will feel drained, but why not have one more summer of getting out and about one more day a week and drinking mostly as I need. My fistula blows because I have been on long term steroids for emphysemia and this has weakened the walls of the veins and arteries as well as making my skin thin. They say they will toughen up after a time. At the moment I am still on a sharp needle but it will be better when I go blunt.

[Sugarlump]

Perhaps a graft in your fistula would help with that. Mine is made of gortex and the needles go in and out of that, thus not affecting the walls of the vein...but it would mean another op.
I reckon if you feel well enough on 2 times a week, go for it. As you say, make the most of it, next summer it might not be the same.

[dialysisuser82]

 
 The reason for 3x/wk I suspect that your Spkt/V is low, meaning you still have a lot of toxin. Even thought you still have output, it does not mean you are safe. When your Spkt/V level is near the

upper range I think you'll can ask for reducing maybe 15". Beside you must have good level- Albumin- Hemoglobin and Iron % Saturation to convince your Neph. for time reduction every so often.



In-center hemodialysis since 1982--33 YEARS
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
No interest in transplant.

3 hours   3x/wk
800 dialysate flow (Qd)    400 blood pump (Qb)
Gambro- Polyflux Revaclear (1.4m2)
Arteriovenous Fistula  33 years
2015 Angioplasty on fistula - caused mild arterial calcification.
Parathyroidectomy 2002
Diagnosis: Glomerulnephristis- High Blood Pressure 1982

[Simon Dog]

Usually, the question "why 3 times a week" is in reference to "why ONLY 3 times a week".  For those without much/any residual function, 3x/week is a cost based compromise that is clearly inferior to either every other day or the almost daily/home protocol.  (for those of us over 100kg, there is nothing "short" about the "short daily" protocol from NxStage).

The conspiracy theorists would conclude that 3x/week is a Medicare/CMS conspiracy to manage the life expectancy of dialysis patients to reduce cost by killing us off earlier.

There are some studies that suggest there may be a residual preserving in limiting the amount of hemodialysis to patients with significant residual function.