Thrice a week vs Twice a week HD.

[OldHat]

I recently started HD and they pulled out a lot of retained fluid….15 litres and counting. I feel much better. Ionly wish it was every 3 days instead of the present thrice a week. I live in India and am 73 years old. I wanted to know how fellow patients how many days and hours is their procedure? Thanks all.

[Bassetmommer]

Everyone has a different amount of time based on prescription, fluid and how much residual urine output they have. Not good to compare.

[OldHat in reply to Bassetmommer]

Thanks for the advice. Will have a chat with the Nephrologist. I feel the thrice a week norm in India is for logistical purposes at the Centre.

[Vius]

After about a year on dialysis (starting at 3x4 hours and going down to 3x3.5 hours), I was part of a Stanford+VA trial to test whether twice a week was possible for certain patients. Ultimately, they determined I could go down to 2x4 hours based on the amount of water accumulation (less than 4L) and toxin accumulation (compared to the dialysis 'clearance' I was achieving) between sessions. The water is an easy metric: I weighed myself every day. For the toxins they had sample sessions where they did blood work before and after the session and also analyzed the wastewater. Finally, there were some cognitive tests along with self evaluations of any physical changes.

Normally (AFAIK) doctors reduce the duration but not the frequency of dialysis unless there is a dramatic change in kidney function. The 3-times-a-week is based on standard protocol, that may be somewhat logistical (not every day) while trying to keep the buildup of toxins minimized (not spaced too much). Functional kidneys remove toxins "continuously", so allowing 44-68 hours of buildup before starting removal again means your body is being stressed by all this accumulated poison. Changing to twice a week makes sessions 3-4 days apart.

The trial study analyzed twice a week (68-92 hours) vs. three times a week (44-68) for a set of patients. We ran for a month in each variation. I don't know how many participants were able to stay on twice a week.

In my case, I had very little water accumulation between sessions (supposedly because my kidneys eventually gave up trying to filter and just let the water through) and low enough toxin accumulation that twice a week was sufficient.

This is for in-center dialysis with a 15-gauge needle in a well-functioning fistula… along with my kidney characteristics.