Are Dialysis Free Weekends Killing Our Patients?

A very intriguing study (done years ago) was posted over at the Renal Fellow Network. For the non medical people out there, your kidney is like a filter. Your blood goes into the kidney, the kidney does its filter magic and you pee out your excess salts, toxins and water. Now, if your kidneys fail you, you have no way to pee out your salts, toxins and water.

So you get dialysis, which is nothing more than an artificial membrane that pulls your blood out of your body, runs it through an artificial membrane, filters it, and then puts the blood back in you. There are several forms of dialysis, the most common of which is hemodialysis (HD). The one everyone thinks of that pulls your blood out, runs it through the machine, and puts it back in you. The normal schedule for HD is three times a week, either Mon-Wed-Fri or Tues-Thurs-Sat.

I have never seen a patient with their normal HD runs on a Sunday. The study from the above link suggests that the dialysis free weekend is killing our patients.

Those with M-W-F dialysis were more likely to die on Monday (dialysis weekend). Those dialyzed on Tues-Thurs-Sat were more likely to die on Tues (their dialysis weekend). And those patients on peritoneal dialysis (PD) had no day of preference for death (PD is done every day, in the home setting). Intriguing to say the least. One day continuous ambulatory renal dialysis will be standard (much like the insulin pump). That is, if our health care system hasn't imploded by then.

I once had a patient once tell me that the outpatient dialysis unit was "ruining my lifestyle". I asked him how so? "Because I have to keep going in". I asked him what his solution was. After missing an entire week of hemodialysis, he says "I can just come to the hospital."

Yes, of course. That's the perfect solution. Inpatient dialysis is all the rage these days. But just don't come during your dialysis weekend. You may not make it until Tuesday.