I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: Home Dialysis => Topic started by: willieandwinnie on March 26, 2006, 05:50:12 AM
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Hi Everyone,
I'm just about at my wits-end. Len (my husband) had he's abdominal wound closed in December and developed breathing problems again. He wouldn't eat much hospital food (imagine that) and he losses weight rather quickly (I always seem to find it). His labs were horrible and they had to give him potassium, he really should of had a blood transfusion but he was right on the border. Our clinic had us come right before Christmas to give Len iron through an IV, he got it again at January's, February and March's clinic. His blood pressures have been uncontrollable since mid December, they actually go up during dialysis. I needed to get his methydopa (500mg) refilled and the mail order service send a information sheet, that I really read this time. It clearly says 2 times you should NOT take with iv iron or iron supplements (which Len also takes), it gives no reason! Anyone have an idea of why?
Also, we have been having trouble with Len's Venus pressures, I don't get much of a flash when I stick him and then I have to keep turning the pump speed down. I have had him to Washington Hospital Center 3 times in the past 3 weeks, 2 venograms with antipastic, one sonogram, two more venograms and 1 dobbler. They say there is nothing wrong. I just don't get it.
Len takes a boat load of medication, he weighs himself a hundred times a day, he watches his intake and can tell you within a quarter a pound of his weight. We pissed out clinic off big time by choosing Sunday, Tuesday and Thursday as our dialysis days. We are only a cash register to them and they make it very obvious with their comments. I don't trust them or the doctors, we have been told out right that we read too much. That just pisses me off so bad.
We have contacted NxStage about their machine so we could at least travel some. I don't know if anything will become of this because of Fresenious, but you never know. I'd love to hear from everyone that uses NxStage about their experience.
Sorry this is so long winded. Blood pressure readings and graph problems have me about ready to go over the hill.
WillieandWinnie
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Last time I had problems with blood flows , had a fistulagram two weeks before that was good. Went to needle one Friday night and no flash,thought we had missed,happens sometimes.. Tried again Sat Morning,still no blood, so we went in to hospital and had it checked out. They found some clotting, with a combination of clot busters and a tool call a rotor router,similar to a dentist drill, they cleaned my graph out and has been working great since. blood flows on Baxter 1550 has been 350-400 with good pressures. We are very lucky here to have an excellent dialysis unit with a great relationship with interventional medicine unit.
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Hi fireguy
We use the Fresenius 2008H and we had been running pump speeds of 450. Now we are down to 400 with good Venus and arterial pressures. It's just makes you crazy when things aren't what they use to be. We love the vascular surgeon, he said we might just have to change the pump speed. Also, since Len's blood pressure readings have been all over the map, we are going to up Len's dry weight by .2 and see what happens. That is one of the nice things about doing this at home, we can change some things and see if it improves other things. Do you get iron? Our clinic is for profit and they let you know this. Pretty sad I'd say. They won't let me give him iron during treatments because they wouldn't be reimbursed for it, like they are when they give it iv on clinic days. Patient comfort and well being not their top priority.
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Our Health care here all covered by Gov. Profit not an issue. Also very lucky to have an excellent dialysis home unit with great support only an hour away or by phone 24 / 7. Yes I get iron as required ,depending on numbers. The unit sends it us and we take care of administering it during dialysis at home.
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WandW,
When you say "high" blood pressure, what is it? Mine is 165/110 and that is "resting." I'm trying all kinds of drugs to get it down.
I think 400 blood pump speed is pretty good. With catheters you only get 300.
Anyway, my question is what is his blood pressure.
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Hi Rerun
We did dialysis this afternoon and Len's pressure sitting before dialysis was 138/81 and after 3 hours and 15 minutes of dialysis he's sitting pressure was 178/89. The go up the whole treatment and I'm confused as why? I told him that maybe he has gained back some of the weight he lost in November and December. There is just so much to learn and keep track of, sometimes it hurts my head.
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I'm no doctor, but I wouldn't freakout over a BP of 178/89. There are various opinions of what "high" blood pressure is. Even the charts keep changing as to when you need to start high BP medications. I think "now" anything over 120/80 you need to look into getting medication.
His sitting at the beginning is GREAT (138/81)! I've been told that the bottom number is important to watch. So, 89 is still pretty good considering what he is going through.
But, you have been watching it rise, so it is good to catch it now.
I'd call my Pharmacy and have them look up the interaction with iron and methydopa. Let us know what you find out. 8)
Hang in there!!! :-\
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Hi Everyone,
I'm just about at my wits-end. Len (my husband) had he's abdominal wound closed in December and developed breathing problems again. He wouldn't eat much hospital food (imagine that) and he losses weight rather quickly (I always seem to find it). His labs were horrible and they had to give him potassium, he really should of had a blood transfusion but he was right on the border. Our clinic had us come right before Christmas to give Len iron through an IV, he got it again at January's, February and March's clinic. His blood pressures have been uncontrollable since mid December, they actually go up during dialysis. I needed to get his methydopa (500mg) refilled and the mail order service send a information sheet, that I really read this time. It clearly says 2 times you should NOT take with iv iron or iron supplements (which Len also takes), it gives no reason! Anyone have an idea of why?
Also, we have been having trouble with Len's Venus pressures, I don't get much of a flash when I stick him and then I have to keep turning the pump speed down. I have had him to Washington Hospital Center 3 times in the past 3 weeks, 2 venograms with antipastic, one sonogram, two more venograms and 1 dobbler. They say there is nothing wrong. I just don't get it.
Len takes a boat load of medication, he weighs himself a hundred times a day, he watches his intake and can tell you within a quarter a pound of his weight. We pissed out clinic off big time by choosing Sunday, Tuesday and Thursday as our dialysis days. We are only a cash register to them and they make it very obvious with their comments. I don't trust them or the doctors, we have been told out right that we read too much. That just pisses me off so bad.
We have contacted NxStage about their machine so we could at least travel some. I don't know if anything will become of this because of Fresenious, but you never know. I'd love to hear from everyone that uses NxStage about their experience.
Sorry this is so long winded. Blood pressure readings and graph problems have me about ready to go over the hill.
WillieandWinnie
Just so you know I have a fisutla and I have not got "Flashback" for YEARS, and my fistula is one of the best at my center. My fistula has been tested and they say it's in perfect working order. I NEVER get "flashback", my fistula is almost 13 years old.
- Epoman
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Hi Everyone,
...We are only a cash register to them and they make it very obvious with their comments. I don't trust them or the doctors, we have been told out right that we read too much. That just pisses me off so bad. ...
>:D :o >:( I would have been livid -- what an insult?!? We checked out 3 local clinics and were disappointed, grossed out, and angry, so I can understand. Damn money hungry, petty idiots would prefer we be ignorant so they can abuse and neglect us w/o us knowing it. >:(
Is there another center where you can go? My husband is set up to train on a NxStage when he starts dialysis (currently at 15% function). The center is about 100 miles away and inconvenient for the few weeks of training but after that the once a month trip will not be too bad. Have you checked out something like that for ya'll?
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Hi Willie and Winnie,
Pump speed 400 not bad, considering I can only get a max pump speed of 250, today 235 with a Venus Pressure 190 going back into a line. Never had much of a flash back even when my fistula was a good one. I suppose I should not complain to much :-\ seeing how it is 26 years old. Plus now I try to get the Nurses to use the lines now and not the fistula. BP hard to say, it's different with how old you are, your weight and sex. BP on the machine today at 120/70 off at 110/75, but I was 0.4 under my target weight.
How often have the Doctors changed his target weight? What I can not understand if he as gained weight and his target weight not changed. Then usually the BP is low, because you are dry. The machine is trying to take off fluid, which is not there to take off, so the BP lowers.
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Pump speed of 450?!?! Holy sh*t :o That would cause high pressures for sure. How many hours of dialysis is he doing? If you dont get any flashback, still try opening the cap to prime with blood....if no blood, withdraw with an empty syringe....if no blood then recannulate. If your really having trouble you need to let someone know.
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450 isn't that ridiculous. I usually run at 450 with arterial pressure around -200 and venous around 180...I have pushed it up to 500 before (-220/200) but i got dizzy watching the pump spin ;D
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Hi Everyone,
I just wanted to update you on my husbands progress. At clinic in April, they stopped Len's EPO completely. He was getting between 10,000 and 15,000 units because his numbers were horrible after November's surgery. After we stopped the EPO, he's arterial and venous pressures started to go back were they were in December. We have been running pump speeds at 440 and 450 again. DFR is 700. When we went to clinic in May they started EPO again, but this time at 2,000 units. We don't draw labs again until the middle of June, so I'll be curious to see numbers.
Thanks to everyone who replied to me. It is nice to hear from other patients about how they deal with the same problems.
WillieandWinnie
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At a pump speed of 450 I would imagine it would be hard to keep the pressures down. My venous goes too high if I run at more than 250! I cant beleive they run people at such a high speed, its just stupid.
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How is running at 450 stupid? as long as the arterial pressure and venous pressure are around -200 and 200 respectively, theres no harm, and the faster pump speed means more blood processed which means cleaner blood...I say if you can get 450, go for it!
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For a very well matured fistula you can run a high blood pump speed. I run mine at 420........it all depends how you feel. If you can handle higher pump speeds without feeling sick or no problems with pressures then go for it.
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That is just how it works over here. Pressures of 200 is too high, and 450 pump speed is crazy. You see in your country the idea of dialysis is hard and fast, which isn't good for your heart. The US have a higher death rate than us, so you do the math.
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That is just how it works over here. Pressures of 200 is too high, and 450 pump speed is crazy. You see in your country the idea of dialysis is hard and fast, which isn't good for your heart. The US have a higher death rate than us, so you do the math.
Actually I'm in Canada, not the US...and the death rate for patients on dialysis in Canada is actually lower than in Australia (15.3 % vs. 15.8%)...In Canada the idea of dialysis is not hard and fast. It's getting the most out of the little time you have. So by having a higher pump speed, you are allowing a much higher amount of blood to be processed and cleaned...I dont see how you can think that pressures of 200 are too high? The average person on dialysis using a central line, will only get a pump speed of about 300, and their pressures will be around 200...The part of being on dialysis that hurts the heart the most, is the increased blood volume that needs to be pumped by the heart. This causes the heart to enlarge, which is quite dangerous.
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Thats just how we have been trained, and it is my general understanding that the fast pump short treatments arent good for your heart. I ran at 250 pump speed both times I had permacathe with no trouble.
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Yeah but aren't you the one who complained about how 3 sessions a week for 4 hours, was not nearly enough dialysis for you? At 250 pump speed, I'm getting almost double the amount of dialysis as you with 450...
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I get adequate dialysis, and Im happy running at 225, Im only young, Id like to live a bit longer yet. How many hours per week do you do?
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I go for 12 hours a week....(3 x 4hrs), my average kt/v is 1.90
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I do 35-40 hours a week. Kt/v on 5hrs a week 250 pump speed was 1.7. Not sure what it is now, I would assume its improved.
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I am on home Hemo I run 8 hours per night my question to Hyper is , I run a 200 pump speed and that is 200 ml per min now if 200 is taken out and 200 is put back in, the way I see it the heart doesnt work any harder no matter what the pump speed is as its taken out of the arm and put right back in , no more blood is being pushed through the heart ?? what did I miss ?
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I am on home Hemo I run 8 hours per night my question to Hyper is , I run a 200 pump speed and that is 200 ml per min now if 200 is taken out and 200 is put back in, the way I see it the heart doesnt work any harder no matter what the pump speed is as its taken out of the arm and put right back in , no more blood is being pushed through the heart ?? what did I miss ?
I think you were referring to where I said:
Actually I'm in Canada, not the US...and the death rate for patients on dialysis in Canada is actually lower than in Australia (15.3 % vs. 15.8%)...In Canada the idea of dialysis is not hard and fast. It's getting the most out of the little time you have. So by having a higher pump speed, you are allowing a much higher amount of blood to be processed and cleaned...I dont see how you can think that pressures of 200 are too high? The average person on dialysis using a central line, will only get a pump speed of about 300, and their pressures will be around 200...The part of being on dialysis that hurts the heart the most, is the increased blood volume that needs to be pumped by the heart. This causes the heart to enlarge, which is quite dangerous.
I wasn't talking about during dialysis...I was talking about in between dialysis sessions. When a dialysis patient drinks something, it isn't filtered out of the blood and excreted like in a normal person. So the blood volume increases. So if you have a goal of lets say 3000, then that means that your heart is pumping an extra 3 L of fluid around...thats what causes your heart to enlarge.
is that what you were referring to?
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Yes I understand what your saying now ok I have another question at the clinic I ran 400 pump speed now that was
96 litres of blood cleaned per run 96 x3=288 per week, then at home I started 6 hr runs 200 pump speed
72x6 =432 per week now I run 8 hrs 6 days
96x6=576 per week
at the clinic my % ran about 69% then when I was on 6 hr runs at home getteing more litres cleaned my % dropped to 59% ?? I will be doing bloodwork tonight to see if doing 8 hours a night has increased my % but cant see why it dropped going from the clinic to Home hemo ?
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Len what do you mean by %?
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Hyperlite have you joined the chatroom yet ?if so try it for a min
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That is just how it works over here. Pressures of 200 is too high, and 450 pump speed is crazy. You see in your country the idea of dialysis is hard and fast, which isn't good for your heart. The US have a higher death rate than us, so you do the math.
Nope, it doesn't apply to Daily-Short dialysis which am doing at the moment..........the high mortality rate has to do with other underlying factors.....inadequate dialysis, in turn causing high blood pressure..the number one cause of deaths......so 3x a week with free days in between doesn't do the cut..........daily-short and Nocturnal everyday do the cut.......
The whole idea is to keep fluid and toxins at bay........
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It is my understanding that the higher the pump speed, the more strain on the heart. Im not 100% on this, Im just going on what Ive been told during my training. I will try find out. When you think about it, the machine is pulling blood from you pretty close to your heart. Surely there would have to be some impact when you are pulling it out at high speeds.
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It is my understanding that the higher the pump speed, the more strain on the heart. Im not 100% on this, Im just going on what Ive been told during my training. I will try find out. When you think about it, the machine is pulling blood from you pretty close to your heart. Surely there would have to be some impact when you are pulling it out at high speeds.
The biggest strain is having too much fluid to take off......that hurts, but for people dialyzing short periods everyday for 2.5 - 2.7 hours and only needing .3 - 1.2lg of fluid taken out and running a blood pump speed of 400-450 will not harm the heart. If you ask why its because the heart is not beeing stretched like a balloon like those people who dialyze 3x a week and coming in with over 2kg of fluid overload.
Its one of the reasons of high mortality rates in the USA..... 3x a week dialysis is not enough.......the whole body is getting damaged very slowly..............I am living proof of that.....I been dialyzing since 1978 and in 2004 went home to dialyze everyday with all my previous years in-center.....today, my hand nerves are damaged, severe carpal tunnel, stiff joints, I don't feel as good as I use to.......if I have started daily-short or Nocturnal dialysis sooner I would have saved time........but am glad I made the switch....my blood pressure is normal now.
But once again, high blood pump speed is hard on people doing 3x a week as they come in with fluid gains over 2kg, and less problemetic with those who do daily-short and nocturnal........
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I'm not talking about fluid gains, I know what that does to you. I'm talking about the pump speed.
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As I see it Amber if you take blood out @400 ml per min its going back into you @ 400 ml a min a few inches away ,therefore it wouldnt have any effect on your heart
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Blood Flow Rate (BFR)
There is a misconception concerning BFR and heart overload. (BFR = Blood Flow Rate)
The heart is overloaded constantly by the extra blood it has to circulate through the shunt (fistula).
Pumping the blood during dialysis doesn't add to the overload.
For example, if you have 1000 cc/min flow in the shunt and your BFR is 400 cc/min, the blood pump doesn't change the total shunt flow, it just takes 400 cc/min from the arterial needle and returns it through the venous needle. In the area between the two needles the blood flow is 600 cc/min.
Of course the BFR cannot be higher than the flow through the shunt. As a rule of thumb, it shouldn't be higher than 50% of the shunt flow.
The rate of waste removal increases as the blood flow increases until BFR is about one half of the DFR (Dialysate Flow Rate). Increasing BFR beyond that doesn't help much. Reducing BFR requires more time for adequate dialysis.
BFR setting is directly linked to the arterial and venous pressure as explained next.
I got that from http://www.pipeline.com/~gil1/esrd/dmachine.htm
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Hyperlite is a:
Science Geek! ;D ;D ;D
Katherine
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Seems I have caused a bit of debate. Im just waiting to get an answer to my question elsewhere and Ill post as soon as I do. :)
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Hyperlite is a:
Science Geek! ;D ;D ;D
Katherine
haha took you this long to figure that out???
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Not really,
Now explain the low dialysate flow rates on a NxStage....... >:D
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Not really,
Now explain the low dialysate flow rates on a NxStage....... >:D
I don't know much about the NxStage system, but from what I do know about dialysate flows, the lower the flow, the longer you go. So basically if you're using a flow of 100, you'll need to do more dialysis to get the same KT/V or dialysis efficacy compared to a 500 flow. The upside is a gentler dialysis. So someone doing daily hemodialysis would be able to use a lower dialysate flow. Someone only doing 3x4hrs would have to use the higher dialysate flow.
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Not really,
Now explain the low dialysate flow rates on a NxStage....... >:D
I don't know much about the NxStage system, but from what I do know about dialysate flows, the lower the flow, the longer you go. So basically if you're using a flow of 100, you'll need to do more dialysis to get the same KT/V or dialysis efficacy compared to a 500 flow. The upside is a gentler dialysis. So someone doing daily hemodialysis would be able to use a lower dialysate flow. Someone only doing 3x4hrs would have to use the higher dialysate flow.
Did you know you don't really need dialysate to have dialysis? All it does is balance electrolytes........that way you don't pass out.......back in the early years of dialysis research patients would drink 5 liters of dialysate orally......
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"All it does is balance electrolytes"
What do you mean ALL it does??? I dont understand what you mean, are you saying we dont need to balance our electrolytes?
I cant see what good it would do drinking the dialysate. I would think it would only raise your K too high and what not.
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Why don't they take 2 cups of blood out and spin the hell out of it and wash, wash, wash, it and put it back in and take the next amount and spin the hell out of it and so on for an hour and we'd be done!
DO I HAVE TO THINK OF EVERYTHING?????? ;D
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Did you know you don't really need dialysate to have dialysis? All it does is balance electrolytes........that way you don't pass out.......back in the early years of dialysis research patients would drink 5 liters of dialysate orally......
Uh, yes you do...The dialysate is basically what "cleans" your blood. The dialysate runs in a "counter-current" flow (so opposite of your blood). It is kept at approximately body temperature and consists of a sterilized solution of mineral ions. Urea and other uremic toxins, as well as potassium and phosphate, diffuse into the dialysis solution. However, concentrations of most mineral ions (eg sodium) are similar to those of normal plasma to prevent loss. So only the stuff you don't need, leaves.
You don't need dialysate to remove fluid though. Fluid removal is achieved by altering the hydrostatic pressure of the blood compartment, causing free water to move across the membrane along a pressure gradient...
Back in the early days, patients might have had to drink dialysate containing electrolytes that would be sucked out. Because they probably didn't have the techniques to mix up a dialysate in the machine that was able to take out the Urea, potassium and phosphate...But i dunno, I don't know how dialysis used to work.
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Of course we need it but in theory its a balance between the outer part and inner part of the dialyzer......but still having UFR on without dialysate releases the larger particles from your blood including fluid. However, you don't want to do that or else you pass out after a few seconds.......
The whole point is that dialysate has nothing to do with how high you set the blood pump speed. If the fistula transonic tests show excellent flow then you can have the blood pump speeds as high as you can tolerate.......
For example, the highest I can tolerate is 430 .....anything higher than that would make me dizzy...........it all depends on you fistula and how high you can go.
On the other hand dialyzing 6-8 hours per night with low pump speeds is the best way to go........molecules like that of Amyloidosis are taken out better......
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Of course we need it but in theory its a balance between the outer part and inner part of the dialyzer......but still having UFR on without dialysate releases the larger particles from your blood including fluid. However, you don't want to do that or else you pass out after a few seconds.......
The whole point is that dialysate has nothing to do with how high you set the blood pump speed. If the fistula transonic tests show excellent flow then you can have the blood pump speeds as high as you can tolerate.......
For example, the highest I can tolerate is 430 .....anything higher than that would make me dizzy...........it all depends on you fistula and how high you can go.
On the other hand dialyzing 6-8 hours per night with low pump speeds is the best way to go........molecules like that of Amyloidosis are taken out better......
Who said that dialysate has anything to do with how high you set the pump speed?
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hyperlite@ I was trained for this stuff........
There are many people confused about dialysate flow speeds, but we know that in-center dialysis machines can be adjusted as high as you want, for that reason is that they need to speed up treatment asap for the patient.....in a very short time at 3x a week.....if its not fast enough then the balance between electrolytes and the blood won't match........that's why they use High Flux dialyzers....that kind of dialysis is not healthy for the patient at 3x a week.......its all about economics....dialyzing alot more patients in one single day.......so they need it fast fast fast.....
Butreal kidneys don't work like that.......Nocturnal nightly dialysis is the answer, then daily-short comes next......
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haha Gus I like how somewhere in your posts, you always put it a little "plug" for homedialysis, and a "knock" against normal 3x a week. ;D
But yeah I agree with you, the higher dialysate flow basically uses more dialysate, and therefore cleans your blood faster. But I don't know what you are talking about when you say if the dialysate isn't fast enough, then the balance between the electrolytes and the blood won't match.
-From what I understand, its just a fancy form of osmosis. So theres two fluids (blood / dialysate) and a membrane in the middle. The dialysate is packed full of stuff you want to keep in your blood (so the gradient is in equilibrium) and therefore that stuff doesn't cross the membrane. But the dialysate doesn't have any of the stuff you are trying to take out, like Urea, Potassium, Phosphates...etc. So therefore those things travel down their concentration gradient, from your blood, through the membrane (by osmosis) and into the dialysate. So if the dialysate is flowing slowly, then it will take longer to clean out all of the blood, because as the "dirty blood" gets to the dialysate, if the "dirty dialysate" hasn't moved on to make room for the fresh dialysate, than the blood will continue on without getting cleaned, until it makes the cycle again. Therefore, faster dialysate, faster clean. The concentration of the stuff you want to keep isn't changing, so it wouldn't matter if the dialysate was flowing fast or slow, as long as it was in contact with the blood (but separated by a selectively permeable membrane).
does that make sense?
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haha Gus I like how somewhere in your posts, you always put it a little "plug" for homedialysis, and a "knock" against normal 3x a week. ;D
Its a fact, 3x a week is not sufficient....people die sooner......I don't want to scare the heck out of you all but your life will not improve doing it 3x a week for over 3 years! Your health will just go downhill.....slowly.......
But yeah I agree with you, the higher dialysate flow basically uses more dialysate, and therefore cleans your blood faster. But I don't know what you are talking about when you say if the dialysate isn't fast enough, then the balance between the electrolytes and the blood won't match.
Keep in mind that the dialysate in-center is not ULTRA-PURE..that's why its fast fast fast, it needs to pass many times......while dialysate for home such as NxStage and Aksys uses Ultra-Pure....which only needs to pass once........some Fresenius machines have Ultra-Pure features.......
-From what I understand, its just a fancy form of osmosis. So theres two fluids (blood / dialysate) and a membrane in the middle. The dialysate is packed full of stuff you want to keep in your blood (so the gradient is in equilibrium) and therefore that stuff doesn't cross the membrane. But the dialysate doesn't have any of the stuff you are trying to take out, like Urea, Potassium, Phosphates...etc. So therefore those things travel down their concentration gradient, from your blood, through the membrane (by osmosis) and into the dialysate. So if the dialysate is flowing slowly, then it will take longer to clean out all of the blood, because as the "dirty blood" gets to the dialysate, if the "dirty dialysate" hasn't moved on to make room for the fresh dialysate, than the blood will continue on without getting cleaned, until it makes the cycle again. Therefore, faster dialysate, faster clean. The concentration of the stuff you want to keep isn't changing, so it wouldn't matter if the dialysate was flowing fast or slow, as long as it was in contact with the blood (but separated by a selectively permeable membrane).
Standard dialysate is acceptable but not the best.....that's why some of us sometimes feel chills, reactions, or even get blood infections..........
does that make sense?
No, hehehe...joking........seriously, Nocturnal, or Dialy-short will prolong your life......its not really the blood pump speed but the whole therapy as in whole.......more frequent dialysis will let you live longer.... :P
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haha Gus I like how somewhere in your posts, you always put it a little "plug" for homedialysis, and a "knock" against normal 3x a week. ;D
But yeah I agree with you, the higher dialysate flow basically uses more dialysate, and therefore cleans your blood faster. But I don't know what you are talking about when you say if the dialysate isn't fast enough, then the balance between the electrolytes and the blood won't match.
-From what I understand, its just a fancy form of osmosis. So theres two fluids (blood / dialysate) and a membrane in the middle. The dialysate is packed full of stuff you want to keep in your blood (so the gradient is in equilibrium) and therefore that stuff doesn't cross the membrane. But the dialysate doesn't have any of the stuff you are trying to take out, like Urea, Potassium, Phosphates...etc. So therefore those things travel down their concentration gradient, from your blood, through the membrane (by osmosis) and into the dialysate. So if the dialysate is flowing slowly, then it will take longer to clean out all of the blood, because as the "dirty blood" gets to the dialysate, if the "dirty dialysate" hasn't moved on to make room for the fresh dialysate, than the blood will continue on without getting cleaned, until it makes the cycle again. Therefore, faster dialysate, faster clean. The concentration of the stuff you want to keep isn't changing, so it wouldn't matter if the dialysate was flowing fast or slow, as long as it was in contact with the blood (but separated by a selectively permeable membrane).
does that make sense?
Well I'm glad someone else mentioned it here on the board instead of PM'ing me (again). It really does get old after awhile and to be honest it always makes me feel like shit. We get it, daily is better than 3X but there are ALOT of people on 3X in-center and they have NO choice. No doubt NxStage is a remarkable machine but when I start it, I won't be constantly reminding people much better I am doing than in-center people doing dialysis 5-6 times a week. I actually have had members PM me and tell me that you come off like an elitist. But honestly Gus, some people myself included get upset when you plug dialy-hemo constantly, we get it already we are all not as lucky as the elite people at the homedialysis site. It makes me feel like I have been cheated all these years and I am doomed. I hope you understand what I am saying and do not get offended. But I personally am getting tired of hearing how much faster 3x'ers are going to die. It's actually insensitive of you. Yeah this is a place to get the truth but lets have some tact. Try to remember that a VERY, VERY small percentage of people can do home/daily due to MANY, MANY factors.
- Epoman
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haha Gus I like how somewhere in your posts, you always put it a little "plug" for homedialysis, and a "knock" against normal 3x a week. ;D
But yeah I agree with you, the higher dialysate flow basically uses more dialysate, and therefore cleans your blood faster. But I don't know what you are talking about when you say if the dialysate isn't fast enough, then the balance between the electrolytes and the blood won't match.
-From what I understand, its just a fancy form of osmosis. So theres two fluids (blood / dialysate) and a membrane in the middle. The dialysate is packed full of stuff you want to keep in your blood (so the gradient is in equilibrium) and therefore that stuff doesn't cross the membrane. But the dialysate doesn't have any of the stuff you are trying to take out, like Urea, Potassium, Phosphates...etc. So therefore those things travel down their concentration gradient, from your blood, through the membrane (by osmosis) and into the dialysate. So if the dialysate is flowing slowly, then it will take longer to clean out all of the blood, because as the "dirty blood" gets to the dialysate, if the "dirty dialysate" hasn't moved on to make room for the fresh dialysate, than the blood will continue on without getting cleaned, until it makes the cycle again. Therefore, faster dialysate, faster clean. The concentration of the stuff you want to keep isn't changing, so it wouldn't matter if the dialysate was flowing fast or slow, as long as it was in contact with the blood (but separated by a selectively permeable membrane).
does that make sense?
Well I'm glad someone else mentioned it here on the board instead of PM'ing me (again). It really does get old after awhile and to be honest it always makes me feel like shit. We get it, daily is better than 3X but there are ALOT of people on 3X in-center and they have NO choice. No doubt NxStage is a remarkable machine but when I start it, I won't be constantly reminding people much better I am doing than in-center people doing dialysis 5-6 times a week. I actually have had members PM me and tell me that you come off like an elitist. But honestly Gus, some people myself included get upset when you plug dialy-hemo constantly, we get it already we are all not as lucky as the elite people at the homedialysis site. It makes me feel like I have been cheated all these years and I am doomed. I hope you understand what I am saying and do not get offended. But I personally am getting tired of hearing how much faster 3x'ers are going to die. It's actually insensitive of you. Yeah this is a place to get the truth but lets have some tact. Try to remember that a VERY, VERY small percentage of people can do home/daily due to MANY, MANY factors.
- Epoman
This thread is about "Home Dialysis" right? So we stick to the subject and the facts........right now, we the community are pushing hard to pass legislation so that in-center patients on a wide basis can have that option, but clearly clearly I say that what I am speaking here is what patients wanting to go home and who can go home get the information straight-hand.
Do you really care about people's lives? Did you already email your congressman to get these bills passed? it a very important issue here and all over the net people want to know the answers about living a long life on dialysis.
Some of you may be unfortunate, you can make choices. You can fight for a better life. Can you? If you really care please visit this page and email your congressman today...... its about peoples lives.....
http://capwiz.com/meiresearch/home/
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haha Gus I like how somewhere in your posts, you always put it a little "plug" for homedialysis, and a "knock" against normal 3x a week. ;D
But yeah I agree with you, the higher dialysate flow basically uses more dialysate, and therefore cleans your blood faster. But I don't know what you are talking about when you say if the dialysate isn't fast enough, then the balance between the electrolytes and the blood won't match.
-From what I understand, its just a fancy form of osmosis. So theres two fluids (blood / dialysate) and a membrane in the middle. The dialysate is packed full of stuff you want to keep in your blood (so the gradient is in equilibrium) and therefore that stuff doesn't cross the membrane. But the dialysate doesn't have any of the stuff you are trying to take out, like Urea, Potassium, Phosphates...etc. So therefore those things travel down their concentration gradient, from your blood, through the membrane (by osmosis) and into the dialysate. So if the dialysate is flowing slowly, then it will take longer to clean out all of the blood, because as the "dirty blood" gets to the dialysate, if the "dirty dialysate" hasn't moved on to make room for the fresh dialysate, than the blood will continue on without getting cleaned, until it makes the cycle again. Therefore, faster dialysate, faster clean. The concentration of the stuff you want to keep isn't changing, so it wouldn't matter if the dialysate was flowing fast or slow, as long as it was in contact with the blood (but separated by a selectively permeable membrane).
does that make sense?
Well I'm glad someone else mentioned it here on the board instead of PM'ing me (again). It really does get old after awhile and to be honest it always makes me feel like shit. We get it, daily is better than 3X but there are ALOT of people on 3X in-center and they have NO choice. No doubt NxStage is a remarkable machine but when I start it, I won't be constantly reminding people much better I am doing than in-center people doing dialysis 5-6 times a week. I actually have had members PM me and tell me that you come off like an elitist. But honestly Gus, some people myself included get upset when you plug dialy-hemo constantly, we get it already we are all not as lucky as the elite people at the homedialysis site. It makes me feel like I have been cheated all these years and I am doomed. I hope you understand what I am saying and do not get offended. But I personally am getting tired of hearing how much faster 3x'ers are going to die. It's actually insensitive of you. Yeah this is a place to get the truth but lets have some tact. Try to remember that a VERY, VERY small percentage of people can do home/daily due to MANY, MANY factors.
- Epoman
This thread is about "Home Dialysis" right? So we stick to the subject and the facts........right now, we the community are pushing hard to pass legislation so that in-center patients on a wide basis can have that option, but clearly clearly I say that what I am speaking here is what patients wanting to go home and who can go home get the information straight-hand.
Do you really care about people's lives? Did you already email your congressman to get these bills passed? it a very important issue here and all over the net people want to know the answers about living a long life on dialysis.
Some of you may be unfortunate, you can make choices. You can fight for a better life. Can you? If you really care please visit this page and email your congressman today...... its about peoples lives.....
http://capwiz.com/meiresearch/home/
You know what I can't believe? I can't believe you have the audacity to ask me if I care about people. I have spent HUNDREDS of hours working on this site, to give people a voice. Let me ask you this what other site do you know related to dialysis has over 5,300+ posts in about 10 short months (did I mention we have MORE posts than Davita's Forum), but that is not the point. I think you missed my point entirely MANY people on dialysis are ALONE and need to be train with a partner. Just because you do it doesn't mean others feel confident enough to do it on their own, plus some can NEVER imagine sticking their own needles, many do not have a fistula, some have other health problems that prohibit NxStage for example, being obese.
As for your email your congressman bullshit, no I haven't and will not. I do my part here on this website. I have enough things on my plate to go kissing some congressman's ass to help us poor unfortunate souls. I really do take offence to your comment "Some of you may be unfortunate" OK we get it but why do you have to rub our nose in it? You are in a 1% sector of patients who do daily-dialysis, does that make you better? Bottom line is stop knocking us people on in-center.
I do care but I don't sit on my high horse and talk down to the "others". Passing laws won't help the people who have the obstacles I mentioned above. So what about the people who CAN'T go home, do they really need to hear what a great thing they are missing out on?
Oh and don't EVER ask me if I care again.
- Epoman
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Your really confusing me Gus :-\ Dont think ill add anymore as I dont know what to say.
I kinda agree with you Epoman, although I do like to plug nocturnal, youve made me realise that I might be offending some people on here. It didnt even occur to me until you mentioned it! Although I am very lucky in being able to do nocturnal, our unit cant offer us short daily either. I did a bit of reading yesterday on the geelong nocturnal website (they started nocturnal over here I think), and they actually favour short daily too. But because of the lack of funding, we cant afford to do it. So I do empathise with those who are unable to do it. I will try to keep my trap shut, Ive already been sort of told to shoosh because our unit has a big waiting list for even just 5hr dialysis.
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I've done home and I've done in center. I'm doing in center for a reason. I don't have to set up and I don't have to tear down and I don't have to do monthly maintenance and I don't have to STORE SUPPLIES. This site is for people who HATE dialysis! Not for those who crave more so they can feel a "tad" bit better.
If EPOMAN didn't care about people, we wouldn't be having this conversation.
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aMbEr_79@ Don't be confused......there hasn't been funding since back in the early 80s.....government hasn't funded any more since then.......but right now there's a large community of Pro-active people like myself who are pushing to change just that......
There's no time for whining about your life.....take action to help people who suffer just like you by contacting your congressman to get some very important bills passed. If we as patients don't stand up we will never accomplish anything.......we really need more funding for patients to have a better dialysis and more options......
EPOMAN@ Your a very high tempered person, you have alot of anger and that's not good. As admin of your site it looks ugly how you try to create flame wars on your own members opinions. What are you gonna do? Ban me? Censor me? Prevent me from giving out the real information and facts about helping people understand more about home dialysis options? I thought your a pro-active person, but maybe I was mistaken. Why bother to have this home dialysis thread? Seems you misunderstand the whole idea here......
This will be my last post here..........I think its not gonna workout.......... anyhow, for anyone who is serious you know where to find me........ ;)
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aMbEr_79@ Don't be confused......there hasn't been funding since back in the early 80s.....government hasn't funded any more since then.......but right now there's a large community of Pro-active people like myself who are pushing to change just that......
There's no time for whining about your life.....take action to help people who suffer just like you by contacting your congressman to get some very important bills passed. If we as patients don't stand up we will never accomplish anything.......we really need more funding for patients to have a better dialysis and more options......
EPOMAN@ Your a very high tempered person, you have alot of anger and that's not good. As admin of your site it looks ugly how you try to create flame wars on your own members opinions. What are you gonna do? Ban me? Censor me? Prevent me from giving out the real information and facts about helping people understand more about home dialysis options? I thought your a pro-active person, but maybe I was mistaken. Why bother to have this home dialysis thread? Seems you misunderstand the whole idea here......
This will be my last post here..........I think its not gonna workout.......... anyhow, for anyone who is serious you know where to find me........ ;)
::) You just don't get it do you, a lot of people are serious but there is no way they could ever do home dialysis, not because of funding but because of the personal reasons I pointed out above. And by you being the POSTER boy for NxStage, you make in-center people feel short changed with your constant, constant downing of 3X a week patients.
BYE!
- Epoman
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Me, for instance! Home dialysis is not even an option. It just doesn't exist here.
I cannot see how ANYONE could try to even insinuate that Epoman doesn't care.
I have no congressman to contact. This is an international site. The purpose of this site is to give people a voice, a place to exchange, to support each other, to help each other, to rant, to vent, to cuss.
Has Epoman AT ANY POINT tried to stop members from getting information and facts???
We WANT information and facts, we just don't want anyone making us feel that what we have is poor crap (we know that already).
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Hey Gus, I hope you get this message before you decide to stop posting here for good. You are a valued member. Your posts are informative, and you've got loads of experience with things like home hemo. BUT you do have to stop slamming 3x4. Yeah it might not be as good as home hemo, but for some people it works just fine. Like for me, it would be impossible to do home hemo. I'm at school, theres no room in my sh*t box hole of a house. Plus its ridiculously unsanitary, and I wouldn't have anyone to help me out...plus I'm hoping to get a transplant within the next year so theres not much point in getting trained and getting my house set up for it. My labs are fine, within all of the required ranges.
I think you're right in promoting home hemo, but don't slam 3x4. I would promote buying a Ferrari if I could get one, but I wouldn't go slamming Hondas...I think a healthy diet, regular exercises and restricting fluids (as well as getting some sleep) are very important to dialysis, and these things can really help to control the "side effects" of dialysis.
But I really hope you change your mind about leaving this site. You're knowledge is greatly appreciated! (and a word to the wise, if you do come back, don't slam Epoman. He puts way too much time effort and $$$ into this site to be disrespected...) but please, DON'T leave us!! ;D
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I hope thats not directed at me Rerun. I dont crave more, I hate doing more, and it makes me feel more than a "tad" bit better.
What government are you talking about Gus? I would say our govt would of had to of put the funding up over the last 20+ years seen as there are alot more people on dialysis. Also one of our major hospitals was completely rebuilt, dont think jo blow would of paid for it.
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I hope thats not directed at me Rerun. I dont crave more, I hate doing more, and it makes me feel more than a "tad" bit better otherwise I wouldnt be doing it.
What government are you talking about Gus? I would say our govt would of had to of put the funding up over the last 20+ years seen as there are alot more people on dialysis. Also one of our major hospitals was completely rebuilt, dont think jo blow would of paid for it.
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I used to feel a lot better on CAPD than Haemo. All my lab results were a lot better on CAPD I had more energy. was on CAPD for 12 years. BUT, at the end CAPD nearly killed me ended up with EPS. Went on Hamo 2000. I have no choice but to do hospital based haemo, my veins are shot at. All I can use just now are lines in my neck. All my results are now sh#t URRs are at 60% can not get pump speeds over 250 most of the time the speed is 230. Had first shunt in 1977 a Venus loop. Which messed all the veins up in my left arm. Had second now called fistula in 1980 it stopped 2001 when I got ESP. Revamped 2002 a scar from my wrist to the top of my arm 44 staples in. I have only got a two inch bit where it can be needled. Had all the test to see if a better excess site can be made. My leg can not be touched. There are no more veins they can use. Not even graphs. So I can NEVER go back on home CAPD/Haemo.
Kevno