Nocturnal Pros and Cons

[dgromley]

Hi, My name is Dawn. I am a dialysis social worker and my clinic is going to be starting a nocturnal program soon. I was hoping to get some feedback from those of you that are involved in the program so I can share the information with my patients. Thanks!

[flipw]

Welcome, Dawn. It's good to have another professional on the site. The things I don't like about nocturnal dialysis are:

* I don't like sleeping with needles in me. I prefer to sleep in my own bed and go to sleep and wake up when I feel like it.

* I still enjoy the night life. I dialyze 9 hrs. per week on the noon shift so my mornings, evenings, and nights belong to me.

* I don't have a need for longer, gentler dialysis. I like to get it over with and not let dialysis impact my life any more than it has to.

* I am retired and don't have to work all day so I don't see the benefits of dialysis at night.

These are just my opinions based on my individual circumstances. I'm sure many others will disagree with me.

[Gustine]

Hi, My name is Dawn. I am a dialysis social worker and my clinic is going to be starting a nocturnal program soon. I was hoping to get some feedback from those of you that are involved in the program so I can share the information with my patients. Thanks!

Hello Dawn, currently am in the Daily-Short program doing 5-6 days a week and am impressed to see more frequent dialysis being offered on other centers.

I am all for more frequent dialysis and can see how increasingly beneficial for us patients who want to live several years more of life.

I have been thinking of trying Nocturnal,but there's a barrier that keeps me from doing it and thats confidence between my caretakers that it will go alright.

On the other hand, I find in-center Nocturnal much better way to go than at home. In-center have many more people/staff on alert keeping an eye on you and at home not.

Awhile back Sacramento State University started the in-center Nocturnal program and you might want to research their program and find out how patients are doing there. The link to that article is at http://www.sacbee.com/101/story/387058.html

[flipw]

I'm hesitant about noctural in center. I don't want this to happen to me.

http://www.sj-r.com/News/stories/29731.asp

[missedtheboat]

Flip, am I reading that article incorrectly? It looks to me that it was not nocturnal. He was hooked up at 7am and found 45 minutes later. This could happen anywhere, anytime, from what I can see.

[Gustine]

I'm hesitant about noctural in center. I don't want this to happen to me.

http://www.sj-r.com/News/stories/29731.asp

That clearly is not Nocturnal, most likely the standard 3x per week sessions.

Flip, am I reading that article incorrectly? It looks to me that it was not nocturnal. He was hooked up at 7am and found 45 minutes later. This could happen anywhere, anytime, from what I can see.

Your right, freak accidents can happen on any type of dialysis modality. No matter whether at home or not or no matter whether its standard, daily-short, or nocturnal....accidents happen. The above article that Flip linked to states that its still under investigation and its a delicate issue trying to come into conclusions.

[flipw]

No, it wasn't nocturnal but if they miss something during the day, what are the odds that they will miss something at night when the patient is sleeping? It's a scary thought.

[Gustine]

No, it wasn't nocturnal but if they miss something during the day, what are the odds that they will miss something at night when the patient is sleeping? It's a scary thought.

Flip, before switching to daily-short I felt the same way, all these questions ran behind my head and the more I worried fear was just building stronger. Finally, I came to a point and asked these questions to myself. "Is frequent dialysis better for my health?" then I researched and found that normal kidneys do most of the work at night and not during day, so Nocturnal is the Gold!! Anyway, I had to start somewhere so Daily-Short was the best choice for me so I decided to kick the fear box out of the way. Change is good my friend and making all these options available to dialysis patients is a must! It doesn't mean you will be forced to choose Nocturnal, it means you will have more options to choose from and our job as patients is to speak out loud so that more dialysis clinics can offer these extra options. Advocating for a better dialysis future will insure our voice is heard.

Anyway, since 2004 I already have been doing dialysis at home and have to tell you how confidence has built up strong! Training/practice is the key to successfull frequent dialysis and if we just stay next to the fear box then we won't be able to progress for ourselves.

Change is good! Fear fear itself.

[cicero]

Re: Nocturnal Pros and Cons

I am a male 74 years old and am in good shape. Good except for ESRD and Pulmonary Hypertension. Currently I am on Hemodialysis in center 3x4hr with a KT/v that hovers around 2. Not bad.
I have just finished touring a 2007 study that suggests the following is statistically true for normalized results.
In Center 3x4 Hemo has an average KT/v =2.46...suggesting I'm less than average.
6xNxStage Hemo has an average KT/v = 3.82 an increase of 39% Not bad at all
3x8 in center nocturnal has an average KT/v = 5.12 an increase of 328% Better than not bad.
Since my chances of death from PH will decrease with the lowering of pressure in my fistula, I am campaigning for Nocturnal in Pinehurst. In addition, currently I am not able to do my exercise program after dialysis, but able on non dialysis days.
The blood flow is lower than 3x4, in fact it is about half as high, so it takes longer to pump all your blood out. I am not fearful of that, but if I become fearful, I'll simply purchase a water leak sensor and place it under my arm.
With everything there is a risk, but weighing the risk against the gain, Damn the torpedoes, full speed ahead.

[BeccaJoie76]

Re: Nocturnal Pros and Cons

Hello everyone. Just a quick side note, I have been a Hemodialysis Technician for 13 years and love every minute of it. I was curious what the article said, the link posted no longer has the article. I was shocked when I read the comment about someone being found 45 minutes later. Please respond. By the way, I see nocturnal as a good way to go. We have a sister clinic that has nocturnal & their kt/v's are great. Have healthy & happy treatments everyone

[Gustine]

Re: Nocturnal Pros and Cons

Heya there,

all kinds of things can happen during a dialysis session and in most cases neither the patient or staff may know it. Back in the years when I did dialysis there was an incident where me and one of the staff spotted some sprinkled blood near my chair and we looked around and didn't see where it may have come. Anyway, they cleaned it and went back to work...well several minutes later that same spot had more blood sprinkles but we looked and looked all over around my area and nothing! Again, they cleaned up and went back to work...finally, for the 3rd time I saw it...a very thin swift sprinkle coming from my fistula! Actually, the needle was starting to make a tiny puncture above the surface of my fistula causing blood to sprinkle....the problem was solved, but imagine in a center where staff are not paying attention? Normally a patient is checked every 30 minutes for vitals, but in some cases staff won't come back to check you over 1/2 an hour! As a staff member of a dialysis clinic you really have to constantly look out for your patients, making brief stops and checking all is okay....

Hello everyone. Just a quick side note, I have been a Hemodialysis Technician for 13 years and love every minute of it. I was curious what the article said, the link posted no longer has the article. I was shocked when I read the comment about someone being found 45 minutes later. Please respond. By the way, I see nocturnal as a good way to go. We have a sister clinic that has nocturnal & their kt/v's are great. Have healthy & happy treatments everyone

[Addie in Canada]

Re: Nocturnal Pros and Cons

Hi There
I live in Hamilton, Ontario, Canada, I was diagnosed with Wengers Granulomatosis in January of 2008, this caused kidney failure and I am on dialysis 3 times a week. I would love to try to arrange a trip to Florida (a place I love) but need to find out the cost of treatments, can anyone help me with this.
Cheers....Addie

[Suzy Q]

Re: Nocturnal Pros and Cons

Hi Addie,
I live in Thornhill, Ont and was born in Hamilton! I investigated dialysis in Florida several weeks ago. Davida have locations there as well as other companies. I looked up the city we were going to, found locations and called. They charged $300 per treatment. We are given back $210 from our government for each one. I just got a cheque in the mail this morning for $210, as we were in Las Vegas in Jan and had one dialysis there. They charged us $500 for it, so it seems to vary according to where you go. The hospital here arranged everything. You have to arrange it well ahead of time and they send your readings to the centre where you're going. It all went smoothly. We called ahead to make sure they had everything and to arrange a time. Hope you get to go! I'm leaving tomorrow for Florida for 2 weeks!

Suzy Q

[Hangpilot]

Re: Nocturnal Pros and Cons

Hi Dawn and others;

I'm currently doing nocturnal in Houston, Tx and have been since Oct. 08. I run 7 hrs 3x a week. My numbers have improved as a rsult of going to nocturnal. My KtV avgs around 2.6. I'm not as rung out afterwards as before doing 4 hr treatments. I have done all 3 shifts and find nocturnal gives me best treatment and frees up the days. I also am a night person and like nightlife, but generally go in around 8:30 -9:00pm and get off around 4:30 - 5:00 am. I'm not working due to other issues, but if I were it would be much easier than trying to shuffle around daytime shifts.

Sleeping in-center is OK and you get used to it. I have a 3" pad I place on chair for extra cush. There is less disturbance during the night. There are 4 patients in our center on nocturnal and we have 1 tech and 1 nurse monitoring us. Same follow-up as daytime with 30 min checks.

I am glad to see other nocturnal centers are opening around country. I am going to Colorado next month and found a center close to the area I will be that also does nocturnal, so my schedule will be the same. Keeping same schedule and treatment will be beneficial.

That's my 2 cents for now. I started out on PD 11/2001, quit due to drain issues (clogging), started hemo 3/02, got dual transplant (kidney&pancreas) 9/02. Kidney gave up 3/06 so I went back to hemo. Pancreas still working perfect. Hemo in center from 3/06 until 10/08 when I went to nocturnal. Considered Home dialysis, but felt to much strain on my wife to have to concern with.

Hangpilot
Houston, TX

[Gustine]

Re: Nocturnal Pros and Cons

Welcome Hangpilot,

do you mind if I ask which clinic is providing the in-center Nocturnal for you?

Thanks for posting about your experience with Nocturnal..