By Bill Peckham
With The Modality Mayhem Of Modern Dialysis Dr Agar runs through the reasons why it is so hard for any of us to answer the question: What is the best dialysis option? On internet discussion forums it is common to see a “plea for help from a new-to-dialysis questioner”, asking What should I do? How should I dialyze?
As Agar writes the resulting discussion can confuse more than it illuminates because the answer is, It all depends. We dialyzors can only say what we have found to work best for ourselves, for our N=1 given the choices we have available. What is needed is universal advice to help guide the decision of which dialysis modality to choose. I offer this, the Peckham Theorem for Dialysis Modality Optimization:
Maximum Amount of dialysis you can stand
Maximum Amount of dialysis you are allowed
If the answer is greater than 1, then dialyze as much as you are allowed, while advocating to be allowed more dialysis. If the answer is less than 1, then it makes sense to ask if you would get more from dialyzing a different way eg. at home, overnight, +/- Qd; questions of lifestyle and how you feel doing what you’re doing come to the fore.
Unfortunately for many dialyzors in the US their number will be greater than 1 and keeping a schedule that never exceeds 43 hours between treatments (the Agar Standard) is not an immediate or mid term option. Thus, my advice if you’re dialyzing incenter three times a week: push your center to offer longer duration treatments, push yourself to dialyze longer. And light a candle that someday a provider somewhere will offer every other day dialysis incenter and that center will be yours.