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October 22, 2011


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Bill Peckham

I'm saying the HDP works as a tool to compare one treatment schedule against another for a dialyzor, not a tool to compare treatment impact between or among dialyzors.

Keeping everything else the same - the machine, Qb, Qd, the patient - the HDP will give the patient some idea what a change in schedule will feel like.

If you know what it feels like to dialyze 5 hours a time 3 days a week, you'll know you'll feel about the same, maybe a little better dialyzing three hours a time 4 days a week. An HDP of 45 vs HDP of 48. HDP is way to predict what a change in schedule will feel like if all else is kept the same.

Ultimately dialysis does have an impact. Some dialysis schedules have more impact than others. We don't have a way to measure this, it certainly isn't measured by urea.

The HDP offers a simple way to compare the impact of various schedules. As someone who has tried a lot of schedules, I think it does as good a job as any measure. It definitely provides a guide to what might be the perceived value of EOD schedules but until EOD is offered we won't know.

theodore patrick

Mr Peckham I completely support your EOD solution.I dialyze 3x's per week and after 4 yrs i stiil can't comply with the industries standards for fluid gain on the weekend.I come in on monday weighing about 5 to 6+ kilos over my dry weight. During the mid week sessions i average about 2 to 4 kilos.I have developed set routines for controling fluid intake during the week.When the weekend comes those routines don't work because of the extra day between sessions. After some thought about my situation i came to the conclusion that the EOD schedule would be the way to go.However that would be an industry change and is seems that it might be to much trouble to implement.My other option is to extend the time of my treatments to where 6 kilo removal is not a problem.I am totally frustrated with the current standards that they expect us to adhere to.I will have to do something soon because the constant struggle with the technicians is unproductive and not worth the stress that their pressure puts me through.It was encouraging to see that someone like you has already come up with a solution that matches with what i was thinking.Now know i can speak with some confidence behind me when i talk to my clinic about my problem.thank you

Bill Peckham

Best of luck Theodore, please update us if there is news. Taking these posts together I feel confident that every other day schedules should be offered and if an EOD schedule was offered I would predict a 20 to 30% initial uptake. There is no reason to deny you the choice.

We'll find out if this would work when a unit tries an EOD schedule (and units will try this in 2012), the verdict will be delivered depending on: does the EOD census grow or shrink after the initial roll out?


Why doesn't anyone talk about recovery? Just curious.

Bill Peckham

You mean no one besides me? It is widely discussed - talking to Dori Schatell at Home Dialysis Central is how I developed a lot of my thinking. I do agree that in the unit it is rarely mentioned and it is too often overlooked when talking about alternative dialysis schedules or even longer treatments leaving frequency alone.

I think in general many units have a blind spot concerning things that happen outside the unit. When these units think of treatment burden they only consider what happens during treatment e.g. cramps, nausea ignoring or not giving adequate weight to the treatment burden once we get home.

Theodore patrick

Hello Bill
I finally got the doctors to prescribe 4x a wk. dialysis i go in Sat. for 2 1/2 HR.s My fluid gains are out of control so they okayed the extra session. I noticed that on Sat after i'm done i feel like i got spring in my step and i'm ready to go out and do something. I still have problems sleeping and they tell me that with the 4th session that i'm getting that it will get better. I'm only sleep 2 or 3 hr at a time. I presented your articles to them on EOD schedules and they were interested but they said that at this particular time that it would take a industry wide change for that to occur. I have concluded that the system wants to give us enough dialysis to keep us alive but when it comes to giving us enough to live as normal a life as possible,You have to fight for it and most people that are in-center are not educated enough about dialysis or doo not feel well enough to do this. I am not one of those people.I am one of two people in my clinic that run 14 guage needles and i am the only one that runs with a 550 flow during dialysis.I found that i get a little cleaner that way. Before that i was having itching problems after dialysis and the doctors were telling me that they did not know what it was from. Well it was from left over toxins that dialysis did not remove. So i figured out how to improve that thru education on the internet and then i went and fought for it and got what i needed. I learned alot during the last 5 yrs since i started dialysis. It seems that i have had to educate my doctors. Luckily i have a good working relationship with the head nephrologist and am able to talk to her on a one to one basis.

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