How does one know if he is getting the best dialysis possible vs adequate dialysis? Would patients feel better if they ran 30 min more a tx then they are prescribed? Are there other ways to increase the efficiency of the tx?

I hate to say this, but it depends!!

There have been some studies that have shown that 'overdialysis' is not good for patients.

With that in mind, I would ask to see your latest adequacy studies. Ask to see your Kt/v results and / or your URR results. These tests will help determine if you received an adequate treatment that day.

Remember, however, that this is just a 'snapshot' picture. If you consistently discontinue treatment every day except 'lab day' you are receiving less dialysis than you need, and the value you may see on your labs is probably 'overinflated'. If there are other problems during treatment: access issues, poor blood flow, interruption in treatments, your adequacy for the treatment would be less than ideal.

Some dialysis machines offer the ability to determine dialysis adequacy each treatment. Ask your clinical staff if they have these type of machines, and if they can use that function.

For more information on dialysis adequacy, go to:
http://www.kidney.org/

and click on the 'K/DOQI' icon. This is the website for the National Kidney Foundation, and the K/DOQI section has a complete section on adequacy of dialysis.

Carol

Carol,

Can you give me an idea of where to find the articles on "over dialysis". I have been following the slow nocturnal articles for quite sometime and there isn't mention of "over dialysis". In the snhd program we are in the patients using their fiscula are getting BVP's of 200 per session 6 nights a week and say they feel fantastic. Our labs are gone over every month and so far no one has been told they are getting "over dialyzed".

Regarding over dialysis, my medical director would say you can't over dialyze because no amount of dialysis is going to replace the normal kidney function. I have had some patients request to dialyze longer because they say they can feel something change between 4-4.5 hours. The is probably one of those molecules, etc. that we have no way to measure but changes the way patients feel.
Dialysis is considered adequate at the URR of above 65% or KT/V of 1.2-1.5. What is optimum dialysis is probably better measured by the way the patient feels. Indicators of good dialysis: Patients looks good, feels good. B/P controlled. Minimum weigh gains. Good appetite. Sleeps well. Absence of itching, nausea, vomiting, restless legs, exhaustion.
Factors that effect how adequate the dialysis is: Time on machine, type of dialyzer, reuse vs non-reuse, blood flow rate, dialysate flow rate, no missed or cut treatments, diet, hemoglobin, number of treatments per week.
Hope this is of value.

Marty:

I will provide a reference list, but give me the weekend to pull things together.

Carol

I run for 3.5 hours 3x/week at 35O with a fistula. I have gotten kt/vs from 1.6 - 1.8. Lets say I asked my neph to let me run for 4.5 hours per tx. Would it still be advisable to run at 350 or would a slower speed be sufficient? Would the components of my tx stay the same? How would 30 min more per tx make me feel..an hour more per tx?

How does the dialysiate rate affect adequacy? Why is dial. rate variable from unit to unit? I've been in units where they ran it at 500 and others where they ran it at 800.

Nate,

An increased dialysate flow rate is the least effective way to increase clearances. Goig from a DFR of 500 up to 800 increases acid, bicarb, and water usage by 60% but it only nets an increase in clearance of less than 10%.

Running at a higher blodd flow rate, larger dialyzer, or longer treatment time are much more effective.