It has recently come to my attention that many patients are cutting their treatment times and signing off early. This is a good opportunity to discuss what exactly dialysis does and why it is important to complete all your treatments.
Dialysis has two major purposes: the removal of toxins and the removal of fluid.
Let’s talk about toxin removal first. Every single day, your body generates toxins. These toxins are removed in part by the kidney. When your kidneys don’t work well, these toxins build up and eventually cause loss of appetite, nausea, vomiting, funny or metallic taste in the mouth, itching, twitching, confusion, difficulty sleeping and fatigue. In addition, these toxins can cause seizures and inflammation around the heart (called pericarditis), inflammation around the lungs (called pleuritis) and even in the belly leading to the accumulation of fluid which we call ascites. Dialysis removes these toxins from the blood. We measure the level of these toxins once a month before and after dialysis. We are looking for at least a 70% reduction in the level of the toxins (this is called the URR). It is important that this level of reduction be achieved EACH AND EVERY dialysis treatment. If you cut your treatment times short, then the level of toxins will then accumulate and over time will increase your risk of getting sick and increase your risk of death. Not meeting these targets therefore endangers your health and safety. Studies done in dialysis patients have shown this to be true.
The second major purpose of dialysis is to remove fluid. Removing fluid helps to keep your blood pressure down and also helps prevent congestive heart failure, which if severe can be life threatening. The best way to avoid fluid build up is to avoid salt in the diet and also to complete your treatments. If you take in too much salt,then you will gain a lot of fluid between treatments. If you gain a lot of fluid between treatments, then you are more likely to experience cramps and an uncomfortable treatment since we will then have to remove all this excess fluid in a short period of time. In addition, if you cut your treatment short, then fluid will continue to build up and it will be more difficult to catch up. Studies have shown that shorter treatment times and having to remove large amounts of fluid in a short time are both associated with greater risks for the patient. It is a matter of common sense that there is less strain on the body if we remove fluids and toxins over a longer, rather than shorter, period of time. For instance, is it easier to run a mile in 5 minutes or 30 minutes?