Optimal Dialysis - HD

The question often arises as to how much dialysis is necessary? I would rather ask the question - how much dialysis is optimal?

Many of us treat dialysis as the problem. It is important to realize that dialysis is the solution (albeit, non-ideal) to the problem of kidney disease. Kidney disease is the problem that dialysis attempts to solve.

For hemodialysis, generally, the more, the better!

Think of it this way: dialysis is attempting to replace kidney function. The kidneys work 24 X 7 without a break, every day of the year, every hour of the day. So, ideally, we should get dialysis 24 X 7, every day of the year, every hour of the day. Anything less is not ideal from the perspective of the function of removing excess fluid and toxins from the body.

But, obviously, that is not practical. So, it would seem logical to say, we should reach as close to the ideal situation as is practically possible without compromising on the quality of life.

Unfortunately, in India, the most common regimens are 4 hours, thrice a week and 5 hours twice a week. Both of these are wholly inadequate. These give rise to a lot of side effects like hypotension (low Blood pressure), cramps during dialysis and the feeling of being totally weak, drained and unwell after dialysis.

There are two modalities that are slowly gaining acceptance in India too (it is more common in Australia, Europe, US and Canada):

1. Short Daily Hemodialysis
2. Daily Nocturnal Hemodialysis

1. Short Daily Hemodialysis: In this modality, patients undergo dialysis six or seven days a week for 2 to 3 hours each day. The advantage with this therapy over the regular twice or thrice a week dialysis is that the amount of time between two treatments is less. This leads to a smaller build up of fluids and toxins which cause a lower rate of removal of these from the blood during dialysis and hence, is gentler on the body.

2. Daily Nocturnal Hemodialysis: In this modality, patients undergo dialysis six or seven times a week at night for seven to eight hours each night. the advantage of this regimen is that not only is the amount of time between treatments less, but the time for removing the toxins and excess fluids is also more. This enables a much lower rate of removal. The dialysis is gentler and more natural. This modality has proven to have the best outcomes. In fact, there have been some studies to show that the outcomes of this modality can compare with that of a transplant!