Dialysis is a medical procedure that takes over the function of failing kidneys, which are no longer able to adequately filter waste products and excess fluid from the blood. Dialysis helps to maintain a stable internal environment by removing these toxins and balancing essential minerals in the bloodstream. This treatment is typically a life-sustaining measure for individuals with end-stage kidney disease. This article explores the consequences that arise when dialysis frequency is reduced from the standard regimen.
Typical Dialysis Schedules
For most individuals with kidney failure, hemodialysis is prescribed three times a week, with each session typically lasting three to four hours. This schedule aims to mimic the continuous filtering function of healthy kidneys, which work 24 hours a day. While dialysis performs only a fraction of a healthy kidney’s work, the standard frequency prevents dangerous buildups of waste and fluid. Peritoneal dialysis, another common treatment, is usually performed daily, often with multiple exchanges throughout the day or overnight. The consistency of these prescribed schedules is important for maintaining fluid and electrolyte balance and for removing accumulated toxins.
Immediate Effects of Fewer Sessions
Reducing dialysis to only twice a week can lead to immediate and serious physiological consequences. Fluid overload (hypervolemia) is a primary issue, as the body cannot eliminate sufficient water. Excess fluid manifests as swelling in the face, hands, legs, and feet, and may cause headaches or abdominal bloating. Fluid in the lungs can cause shortness of breath, while increased bloodstream fluid elevates blood pressure, straining the heart.
Inadequate dialysis also causes a rapid buildup of waste products and imbalances in electrolytes. High potassium (hyperkalemia) can lead to abdominal cramping, muscle weakness, irregular heart rhythms, or cardiac arrest. Excess sodium (hypernatremia) can result in disorientation and muscle twitching, while calcium and phosphorus imbalances may cause muscle spasms and seizures. These acute changes quickly lead to uremic symptoms, including severe nausea, vomiting, fatigue, confusion, and widespread itching, as toxins accumulate.
Long-Term Health Risks
Sustained insufficient dialysis, such as receiving treatment only twice a week, leads to cumulative health deterioration over time. Cardiovascular complications are a leading cause of death among individuals on dialysis. Chronic fluid overload and high blood pressure can enlarge and weaken the heart, leading to heart failure, coronary artery disease, and sudden cardiac death. The persistent presence of toxins also contributes to inflammation and hardening of blood vessels.
Bone disease, known as renal osteodystrophy, is another common problem stemming from prolonged imbalanced mineral levels. Kidneys regulate calcium, phosphorus, and vitamin D; impaired function leads to weakened bones, bone pain, and a higher fracture risk. Malnutrition is prevalent among dialysis patients, partly due to treatment’s catabolic effects and reduced appetite from uremia. This state increases susceptibility to infections and worsens overall health outcomes.
Anemia (reduced red blood cells) is almost universal in kidney failure and exacerbated by inadequate dialysis. Kidneys produce erythropoietin, which stimulates red blood cell production; insufficient dialysis worsens this deficiency, leading to severe fatigue and shortness of breath. Nerve damage (neuropathy), particularly affecting hands and feet, can progress due to ongoing toxin accumulation harming nerve fibers.
Reasons for Reduced Dialysis Frequency
Several factors can contribute to a patient receiving dialysis only twice a week. Sometimes, this reduction is due to unintentional circumstances like missed appointments from transportation issues, scheduling conflicts, or personal emergencies. Logistical challenges, including limited access to centers or insufficient machine availability, can force a reduced schedule. Financial constraints or lack of support systems might prevent consistent adherence to the treatment plan.
In rare medical scenarios, a reduced frequency might be considered by the medical team, but this is not the standard approach. Patients with significant residual kidney function who still produce urine and clear some waste might initially require less frequent dialysis. In certain palliative care situations, where the focus shifts from prolonging life to comfort, a less intensive dialysis schedule might be agreed upon. However, many instances of reduced frequency stem from a patient’s personal decision, often against medical advice due to treatment burden or other reasons, carrying substantial risks.
What to Do If Dialysis is Missed or Reduced
If a dialysis session is missed or if there is any consideration of reducing treatment frequency, immediate communication with the healthcare team is important. This includes contacting the nephrologist, dialysis unit, or other care team members as soon as possible. They can assess the individual’s condition, evaluate the risks of reduced treatment, and provide guidance on how to proceed safely. Self-reducing dialysis frequency can have severe and life-threatening consequences.
Adherence to the prescribed dialysis schedule is important for managing kidney disease and maintaining health. The healthcare team can work with patients to address barriers to consistent treatment, such as logistical difficulties or personal challenges. In some cases, under medical supervision, treatment plan adjustments might better fit a patient’s needs while ensuring adequate waste and fluid removal. Open dialogue with medical professionals is important to optimize care and avoid complications.