I posted this on another BB for nephrologists and have received no responses. Here goes: A person is considered to be in ESRD when their residual kidney function drops below about 10 %. Why does the average hemodialysis patient in the U.S.A. only dialyze 6 % of every week ? Isn't this a straight-forward argument for longer dialysis treatments ? Too K.I.S.S. ?

The two variables you mention have no correlation that is useful in prescribing dialysis therapy.

However, it does remind me of a sign that my uncle had posted in his fishing cabin:

If three-quarters of the earth is covered by water, shouldn't we spend three-quarters of our time fishing?

"Sorry" - Thanks for the response but it would be nice to feel like there was at least an attempt to think about the question. First, I would not suggest that this be used for prescribing dialysis regimens. Further, I would agree that it is a great oversimplification to believe there is a simple one-to-one correlation here, however, if 10 % kidney function 24 hours a day is not sufficient, why would we think that dialysis 3x per week for an average of 3.25 to 3.5 hours (6% of the hours in a week) is ?! Remember, we are talking AVERAGES here. Remember, also, that the mortality rate is 22%.

There are numerous articles indicating 3x a week dialysis is not adequate. This has been studied since 1969 and it is only today some patients can get into slow nocturnal programs.

I do slow nocturnal with my father. I showed his labs to a nephrologist who had never seen the labs of a slow nocturnal patient.

I quote from the doctor: "This is too good to be true - but it is". He is now initiating the start of a slow nocturnal program.

Yes, what is stopping Medicare from approving payment for slow nocturnal dialysis programs? Patients would flock to it if their doctors made it available and told them how easy it is to do in their homes.

Hi Brian, My p.c.p. said (back in August) I should be put on dialysis. He sent me to a nephrologist, who disagreed. He told me the criteria used depends on the individual involved. In my case I'm 46, not overweight, and have no other health problems. It's now the end of March; not on dialysis yet, but will be as soon as fistula matures. Dr. said if I had heart problems or was diabetic and esrd I would already be on dialysis.