This is Jeffrey Berns, Editor-in-Chief of Medscape Nephrology. I was catching up on some reading over the weekend and ran across a very interesting article by Rayner and colleagues in the American Journal of Kidney Diseases. They report a survey of about 6000 hemodialysis patients from around the world. This study was part of the Dialysis Outcomes and Practice Pattern Study (DOPPS). The gist of the study was asking 3-times-weekly dialysis patients a very simple question: How long does it take you to recover from a dialysis session?
About one third of the patients said recovery took less than 2 hours, 41% said it took 2-6 hours, 17% took 7-12 hours, and 10% took more than 12 hours to get back to normal after a dialysis session.
What were interesting were the associations between postdialysis recovery time and some clinical and quality-of-life parameters. Older age, longer dialysis vintage, and diabetes were all associated with longer recovery times. So were greater intradialytic weight loss and ultrafiltration rates with a U-shaped curve, meaning that rates < 5 mL/min and > 15 mL/min were both associated with longer recovery times compared with 5-15 mL/min. Longer dialysis treatment time and lower dialysate sodium concentration (< 140 mEq/L vs > 140 mEq/L) are also associated with longer recovery.
Longer recovery times after dialysis were also associated with poorer health-related quality of life, which is not a surprise. Patients with longer recovery times had a 20% greater likelihood of having a first hospitalization and about a 50% increase in mortality, so recovery time has a substantial impact.
This seems to be actionable -- something that we might be able to influence with our patients. This was an observational study, so it doesn't prove cause and effect, but it would be interesting when making rounds in the dialysis unit to ask patients this very simple question and then think about whether the treatment can be altered in some way to allow shorter recovery times. Two hours is probably a long time for recovery from treatment, but certainly 6-12 hours or longer seems as though it would be relatively intolerable to a patient who has to go through this 3 times every week. It might help to change the ultrafiltration rate, the dialysate sodium concentration, or the duration of the dialysis treatment, and think about switching patients to peritoneal dialysis if they are having a very difficult time recovering from dialysis.
This is a very interesting study, and it suggests that there are some opportunities to help our patients feel better through simple manipulations of the dialysis treatment, and asking them this very simple question from time to time: "How long does it take you to recover from your dialysis session?"
This is Jeffrey Berns, Editor-in-Chief of Medscape Nephrology.
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Cite this: Ask Patients About Recovery Time Post-dialysis - Medscape - Aug 22, 2014.