How is Successful Hemodialysis Measured?
How is successful hemodialysis measured?
In my experience, no single measurement of hemodialysis success is universally accepted. Two measures can give you a time view: your monthly clearance rates two months in a row and blood urea nitrogen (BUN), a measure of urea and nitrogen levels in your monthly blood tests. There are other indicators of success starting with the dialysis machine.
The proper settings are important for dialysis
Before each session, two important settings are entered based on my age, experiences encountered in previous sessions, my weight pre-dialysis, and my blood pressure. The first setting specifies the amount of poisons to be filtered out during dialysis. If my kidneys were operating correctly, poisons would be filtered out 24 hours a day, 7 days a week. Since dialysis is only done 3 days a week for approximately 3 hours a session, there is a theoretical limit to the amount of poisons hemodialysis can filter in 12-plus hours a week; It can remove only a proportion of the poisons accumulated in my blood between sessions.
Luckily, dialysis is slightly faster than my kidneys. My kidneys are still functioning at some level: I’m still passing a lot of urine; my body does eliminate some urea; and urea doesn’t accumulate at the same rate day to day. Otherwise, one might never get ahead or stay even in the urea game.
The second setting specifies the removal of a specific quantity of the retained fluids accumulated between dialysis sessions. If the goals of both settings are met at the end of the treatment session, many would interpret that as successful dialysis for that session. If the settings were achieved on multiple days, many would view dialysis as being successfully performed.
Blood tests can show how well hemodialysis is working for CKD
Monthly blood draws that meet their test objectives multiple times may also be interpreted as dialysis success. One particular test, BUN, measures the amount of blood urea in your blood. A low or decreasing-over-time BUN number is often interpreted as one indicator of successful dialysis. If your BUN number is high or is increasing over time, that might be interpreted as your dialysis is not working well and the various dialysis machine settings should be reviewed and changed for better dialysis treatment.1
High BUN numbers can also be attributed to other factors.
A few other reasons your BUN level might be higher than normal include:
- Dehydration (too little fluid in your body)
- Burns
- Infections
- Certain medicines
- A high-protein diet
- A recent heart attack 2
Your BUN number might sometimes be low due to these factors:
- Very low protein diet
- Malnutrition or starvation
- Liver disease (impaired urea production)3
I keep fighting even as my chronic kidney disease progresses
My nephrologist and her staff have provided excellent care over the last 20-plus years in managing my kidney issues and have, in my mind, been a major factor in extending the useful life of my kidneys way beyond my expectations and delaying my having to go on dialysis for years.
At some point, I realized we were fighting a losing battle because my kidneys were already so damaged from the crystals and stones. In spite of all good efforts, I was progressing through the chronic kidney disease stages. Recognizing what the end game might be has not stopped me from continuing to fight my CKD and even, in some cases, my dialysis journey.Recent hospitalizations for serious infections caused further damage to my kidneys and I have progressed to CKD Stage 5 and I am now on dialysis.
Join the conversation