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By Douglass Domoto, M.D., J.D.
When you were young, did you ever ride a merry-go-round or a roller coaster at the carnival or the amusement park? Whether it was the easy-going merry-go-round or the wild roller coaster, when the ride ended, I bet you wished it had lasted longer. Even with all the “ups and downs” in the ride, that’s what you expected. And, you would have been mad if the ride ever ended early. In some ways, your dialysis treatments can be compared to these rides you took as a child.
There may be “ups and down” in your dialysis treatments. The “ups” are the good feelings you get when the extra fluid and waste products are removed. The “downs” may be the bad feelings you get if your blood pressure drops too low, if you get cramps or otherwise feel ill. However, it is important you stay on for your full dialysis treatment.
The amusement park rides you took were for fun and excitement. The dialysis treatments you take now are for your health and well-being. Your physician prescribes the length of time your dialysis treatment lasts based on the time it takes to remove a sufficient amount of fluid and waste products from your body. You may have heard your dietitian, doctor, or another caregiver say “Kt/V” or “URR.” These letters refer to the lab tests that measure how much dialysis or "cleaning" you get during your dialysis treatment. DaVita's goals for Kt/V and URR are based on national standards set to increase your chances of staying well.
Your adequacy of dialysis can only be improved in three ways. The dialyzer-filter can be changed to the most efficient one available. The blood flow from your access can be turned up to the maximum. If those two steps don’t provide adequate dialysis, the only choice left is to increase your treatment time.
DaVita’s goal is to have your Kt/V above 1.2 with an optimal goal of 1.4 or greater. The goal for URR is a mimimum of 65%. Previously, I used the word “adequacy.” I did not call it “good,” "best" or “highest quality” dialysis. It is called only adequate dialysis. This amount of dialysis is the minimum amount needed to keep you feeling well, have a good appetite and increase your chances of not getting so sick that you have to be in a hospital. There are studies that show patients who get more dialysis time (for example, nightly dialysis) feel better, eat better and are able to be more active.
There is another reason to stay on for your prescribed dialysis time. The goal of each treatment is to remove enough fluid to get you to your dry weight. If you have a lot of extra fluid, you will need your full time, and sometimes, even more time to take off all the extra fluid. You are more likely to feel sick, get cramps or have your blood pressure drop if the same amount of fluid is removed in a shorter time period.
Some people get sick on amusement park rides. On a ride you don’t have a choice. You are on until it ends. When you take your dialysis treatments, you do have a choice. I encourage you to stay on and get your full treatment for your own health and well-being. It is worth the “ups and downs.”
Dr. Domoto is a DaVita nephrologist in St. Louis, Missouri. He received his undergraduate degree at Stanford University (June 1965) and went on to Yale University School of Medicine for his M.D. (June 1969). Dr. Domoto served as Chief Medical Officer in the U.S. Army (1972-1974). He also earned a law degree from St. Louis University School of Law (May 1995).
Medical Professional Associations include: American Society of Nephrology, International Society of Nephrology, National Kidney Foundation, American Society for Hypertension and the Renal Physician Associations.
Dr. Domoto has enjoyed a distinguished career in nephrology and has received grants and performed many clinical studies to advance discoveries about chronic kidney disease.
He is married and has one daughter.
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