Hemodialysis: Why more is better

(Disclaimer: This article is only based on the personal experience of the author. Do not consider this as medical advice. Follow the advice of your doctor and never make changes to your life without consulting them.

Many people ask me this question: How many times a week do you do dialysis? My answer usually shocks them. 5 nights a week, 7.5 hours each night.

Their reaction varies from disbelief to sadness. Disbelief because they think that is not possible. Sadness because they think I am in such an advanced stage of kidney failure that I need that much dialysis when they are used to only twice or thrice a week, four hours each time.

I often come across people who wonder why they should do thrice a week when they feel fine with twice a week?

The answer is very simple.

What is dialysis? Dialysis is replacement of kidney function. During a dialysis session, the dialyser (which is a sort of artificial kidney) removes toxins and fluids just like a normal kidney would. However, it is nowhere nearly as efficient as a natural kidney. 

Natural kidneys work 24 hours a day, 7 days a week. This is 168 hours per week. Most people dialyse twice or thrice a week for four hours each time. That comes to only about 8 or 12 hours a week. So this is hardly as efficient as natural kidneys.

While it is impractical for us to be on dialysis 24X7, we should aspire to reach as close to that as practically possible, right? Only then will we reach anywhere close to the functioning of our native kidneys.

By getting more hours of dialysis, not only do we ensure better clearance of toxins, we also ensure that fluid is removed at a gentle rate. By having less gap between two sessions, we ensure that the fluid never builds up to dangerous levels. Also, by doing extended hours of dialysis, we ensure that whatever fluid has accumulated is removed over a longer duration at a lower rate. Removing fluid at higher rates is dangerous for the body, especially the heart. Research has shown that fluid removal rates greater than 13 ml/kg body weight/hour is very dangerous for the body. Between 10 to 13 is slightly dangerous. Below 10 is safe.

So, if someone has a body weight of about 60 kg, then removing over 3.12 kg during a 4 hour session is very dangerous and removing over 2.4 kg slightly dangerous.

Some people might think that I am recommending more hemodialysis because I co-founded a dialysis provider company. However, that is not the case. What I am saying is backed by solid research, and many studies have shown the above facts to be true. I follow this advice myself. What more can I say?

To those who still question this logic, maybe try more frequent, longer duration dialysis for a few weeks. If you feel better and your blood investigations are better, consider continuing. If not, you can always switch back, right?