How Much Dialysis is Adequate Dialysis?

A very difficult question indeed!! I would prefer to say that NO dialysis adequately replaces the function of the normal kidney. A normal kidney works every second, every minute, 60mins per hour, 1440 minutes in a day, i.e. around 10000 minutes a week. Most ESRD patients in the world are on thrice weekly - 4 hour sessions,
which makes it 12 hours per week, i.e. only 720 mins per week (not even 10% of time that the normal kidney works) Some guys get dialyzed only twice a week. Imagine how less this would be ... only 8 hours a week, i.e. only 480 mins per week (less then even 5% of the time that our normal kidney gives us). And on the other side there are some bravehearts getting laid daily by dialysis. Kudos to them!!

So, how do we decide how much is good for us? Do we get dialysed exactly the same duration that the natural kidney works? Impossible isn't it ... imagine having to be plugged on to the dialysis machine round-the-clock ... scary! It is a well known fact that those who undergo daily dialysis are more closer to being normal than others, more so if it is a daily 6-8 hours of night-time (nocturnal) dialysis instead of the conventional 4 hours. However, it may not be possible for everyone and we will then be forced to find out the minimum amount of dialysis to keep us healthy.

Again ... how much dialysis is enough? We should remember that the aim of doing dialysis is to keep ourselves symptom-free, get BP control and have minimum medicines to consume. Dialysis is considered minimally adequate if there is no swelling (or very mild swelling) and no difficulty in breathing even just before the start of a dialysis session or at night while lying down, when appetite is good and there is a craving for eating food, when the patient is able to carry out all his routine activities at home, outside and at workplace with utmost ease, when BP is under fairly good control with minimum BP medication, and when there is no weakness / tiredness after a dialysis session. If the person does not fit into any of the above criteria he/she probably needs more dialysis than what is actually going on. So, minimum requirement of dialysis is not fixed, varies from person to person. Most may be comfortable with a 3-times-a-week schedule, some may need 4 sessions a week, some may need 5, few may need daily dialysis.

There are some patients who are on less than 3 sessions per week of hemodialysis. It should be strongly noted that a 2-times-a-week schedule is grossly inadequate. A weekly-once schedule is of absolutely no benefit and it may be better to be without dialysis and save the money being spent on the single session per week.

Therefore, it is important to realize that there need not be a fixed prescription for dialysis. The patient himself must introspect and find out from time to time whether he is feeling well with the current program or he needs to upgrade it. And ... the rule, "MORE DIALYSIS IS ALWAYS BETTER" still stands strong.