Tension Between Dialysis Patients' Desires And Nephrologists' Goals Impact Overall Health Outcomes

For most Dialysis patients their two biggest day-to-day challenges are (1) abiding by their recommended Renal (Kidney) diet and (2) maintaining adequate fluid restrictions so they do not over drink and suffer fluid overload (too much fluid in the body). The easy solution to both of these issues is simple, increase the amount of time for Dialysis treatments which patients conduct. Here is the problem, however, most Dialysis patients are staunchly (very strongly) against increasing their Dialysis time by literally even a single minute.

Recommended Reading: Reevaluating Chronic Kidney Disease Patients' Weight Increases Between Dialysis Treatments 

A leading cause of death in Chronic Kidney Disease patients on Dialysis is not the insidious disease itself which they must fight, it is most often Heart Failure. According to Dr. Jeffrey Berns (Editor-In-Chief of Medscape Nephrology), by increasing the treatment times of Dialysis patients and reducing the rate of ultrafiltration (filtering and cleaning of blood) during Hemodialysis to between 10 and 13 mL/kg/hour may improve Dialysis patients' survival, "as more rapid ultrafiltration rates have been associated with poorer health outcomes, including mortality, among patients receiving Dialysis." 

Recommended Reading: Making Your Dialysis Treatments Come Alive and Less of a Chore

However, many patients feel as though they spend much of their lives away from family, friends, and unable to conduct activities that they enjoy because they are "stuck to a machine." When the question of extending Dialysis treatment times was presented on the KidneyBuzz.com Facebook Fan page, a few responses included. 

Scott Kalchert: "No.. I'd rather do home Hemodialysis than have to sit there any longer than I have to"

Cathy Cressman Sebastian: "No not really. Don't find the restrictions that bad, - maybe I'm just so accustomed to it they don't bother me anymore."  

Scott and Cathy's sentiments are not uncommon. In fact, a study conducted by Jennifer Flythe and published in the American Society of Nephrology revealed that of the 600 Dialysis patients interviewed only 44% would be willing to extend their treatment by 15 minutes if they could "avoid a fluid restriction entirely." How about a 30 minute extension for no fluid restriction? Well, the numbers drop drastically to a meager 21% of those interviewed, and 10% if they had to spend 45 minutes extra on their machine. What's more, only 12% were willing to add a fourth dialysis treatment to their week.

Recommended Reading: Study: Longer Time on Dialysis Worsens Post-transplant Outcomes

Another interesting aspect of the study is that even the majority of patients who are bothered by fluid overload or edema (swelling) are not willing to extend their treatment times by more than 15 minutes.  Although the patients who are most impacted by the fluid restriction are more willing to extend their treatment times a bit, the large majority will be willing to extend it by no more than 15 minutes. Also, the study findings suggest that "having dyspnea (shortness of breath) at rest, or cramping during Dialysis, does not incentivize Chronic Kidney Disease patients on Dialysis to extend their treatment times.

Recommended Reading: How Chronic Kidney Disease Patients Can Stop Feeling Completely "Wiped Out" After Dialysis Treatment

These findings seem to put Dialysis patients at odds with their Nephrologists, many of whom would like to see Dialysis times increase in order to reduce "the tremendous morbidity (refers to the disease state of an individual) and mortality, and the high hospitalization and complication rates, in patients on dialysis," according to Dr. Berns. What do you think? Would you be willing to spend more time on Dialysis to reduce your fluid restriction and/or diet? If so, how much longer. Share your response on the KidneyBuzz.com Facebook Fan Page by clicking on the following link (https://www.facebook.com/pages/KidneyBuzz/347471888696381). 

Recommended Reading: How Much Fluid Should Dialysis Patients Remove During Dialysis To Improve Their Outcomes?

If you would like to take advantage of some or all of the health benefits associated with extending your Dialysis time which are outlined above, fill out the below form for more information on Nocturnal HOME Dialysis. This is a brand new Hemodialysis Treatment recently approved by the Food and Drug Administration that allows people to conduct Nocturnal Hemodialysis Treatments from the comfort of their beds while sleeping. Also, visit KidneyBuzz.com for the latest Breaking News & Information about how Chronic Kidney Disease, Dialysis, and Diabetic patients can better manage their lives. 

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"Dialysis Pits Patients' Desires Against Clinicians' Goals." Http://www.medscape.com. Medscape Log In.

"Fluid Management: The Challenge of Defining Standards of Care." National Center for Biotechnology Information. U.S. National Library of Medicine.