Blood flow rate and fistula survival

[obsidianom]

 "Final AVF failure rates were higher in facilities with higher median blood flow rates (BFR). They were also greater in North America and EUR "

This line was from a brand new article about to be published . It showed that higher blood flow rates (blood speed) leads to higher fistula failure rates. Remenber this when you are in dialysis. Those at home slow down blood flow, those in center who can,  try to slow it down . This came from Nephron Clinical Practice  Sept. 12, 2013.
They studied many cliinics in many counties and found the slower the blood flow rate , the better the fistula survival. It certainly makes sense to me. Slower rates put less force and pressure on the fistula.

[obsidianom]

This article backs up slowing down speed of blood as they found FEWER changes in the blood cells themselves as they slowed down the blood flow rate. So speed effects the actual cell structure of red cells . The filter itself has an effect , but it is heightened by increased speed.


Clin Hemorheol Microcirc. 2013 Sep 4. [Epub ahead of print]

The passage of a hemodialysis filter affects hemorheology, red cell shape, and platelet aggregation.

Reinhart WH, Cagienard F, Schulzki T, Venzin RM.


Source

Department of Internal Medicine, Kantonsspital Graubünden, Chur, Switzerland.


Abstract


We investigated the influence of the passage of a hemodialysis filter on red blood cells (RBCs), platelets, and hemorheological parameters. After one hour of hemodialysis, blood was drawn from 15 patients immediately ahead and behind the dialysis filter. RBCs were fixed for morphological analysis. Blood viscosity was measured with a Couette viscometer (LS-30, Contraves), RBC aggregation with a Myrenne aggregometer, platelet aggregation in flowing whole blood and in platelet rich plasma. The passage of the hemodialysis filter increased the hematocrit from 34.0 ± 3.8 to 44.6 ± 8.7% (p < 0.01). Discocytes decreased from 73 ± 9 to 60 ± 15%, while echinocytes/knizocytes were more abundant 24 ± 9% and 38 ± 15%, respectively, p < 0.01). Blood viscosity increased from 3.77 ± 0.52 to 6.75 ± 2.21 mPa.s (p < 0.01). The RBC aggregation index decreased from 25.8 ± 5.0 to 20.9 ± 5.6 (p < 0.05). These changes were less pronounced when the blood flow rate was reduced from 350 to 100 ml/min. Platelet aggregation was slightly increased in flowing whole blood, but decreased in platelet rich plasma. At the end of hemodialysis, a small increase in abnormally shaped RBCs, hematocrit, and whole blood viscosity persisted; platelet aggregation in flowing whole blood was reduced in all patients. We conclude that the passage of a hemodialysis filter induced RBC shape changes, increased the hematocrit, whole blood and plasma viscosity, decreased RBC aggregation, and affected platelet aggregation

[Rerun]

They originally went with Hi Flux Dialysis because people did not want to sit there for 5 hours.  Now it has come around to a lower blood flow and longer sit times.  At least at Nocturnal I can sleep for most of the 8 hours.  My problem is when I sleep my BP gets low and they have to shut off my UF and I have fluid aboard.  Plus it stays in my fact.  Joy!

[obsidianom]

They originally went with Hi Flux Dialysis because people did not want to sit there for 5 hours.  Now it has come around to a lower blood flow and longer sit times.  At least at Nocturnal I can sleep for most of the 8 hours.  My problem is when I sleep my BP gets low and they have to shut off my UF and I have fluid aboard.  Plus it stays in my fact.  Joy!

As always there is no perfect solution for everyone. I just have seen that even a small decrease in speed (say about 20 to 30 reduction) rerduces the pressures in the line/ fistula some which reduces the stress on it. If people watch the pressures on the the machine they can see what slowing down the blood speed a little at a time can do to the pressures. That is what really matters anyway. In some cases it may only be a small amount to gain some significant pressure reduction. Some change is better than none here. There can be a balance between time and speed .
I plan to slow my wifes speed from now on from 380 to 350.  I will moniter the pressures for a few days at that speed. I know what I have been getting for pressures , so I will see what this does over time. It shouldnt add too much time to the treatment. And as Hemo doc says, even 15 minutes longer on dialysis increases life span . So its a good trade off.

[Dman73]

Five years ago I tried to explain the benefit of lower pump speed and increased duration to my nephrologist with the reason being creating less stress on the fistula & heart. He wanted to see proof which I provided buy he did not agree with.

I wanted to increase my time from 3 1/2 hrs to 4 and reduce my pump speed from 450 to 350.

During our discussion he concluded that I will run the short time at the higher speed and started to walk away. I then exclaimed to him in front of everyone that the only reason for doing that was money. He stopped, turned around and was surprised at my comment and stated the he was the doctor and director of the clinic and that is the way it will be.

I received a letter the following week that I need to find a different D center & nephrologist as he is releasing me from his care. The reason being that slavery doesn't exist and he no longer wants to treat me and that he would follow me for the time it would take to make those arrangements.

Currently I have a different center/nephrologist and run 4hr at 350.   

[obsidianom]

Five years ago I tried to explain the benefit of lower pump speed and increased duration to my nephrologist with the reason being creating less stress on the fistula & heart. He wanted to see proof which I provided buy he did not agree with.

I wanted to increase my time from 3 1/2 hrs to 4 and reduce my pump speed from 450 to 350.

During our discussion he concluded that I will run the short time at the higher speed and started to walk away. I then exclaimed to him in front of everyone that the only reason for doing that was money. He stopped, turned around and was surprised at my comment and stated the he was the doctor and director of the clinic and that is the way it will be.

I received a letter the following week that I need to find a different D center & nephrologist as he is releasing me from his care. The reason being that slavery doesn't exist and he no longer wants to treat me and that he would follow me for the time it would take to make those arrangements.

Currently I have a different center/nephrologist and run 4hr at 350.   

You absolutely did the right thing. The arrogance of some doctors appalls and embarreses me. The research is clear and common sense alone indicates slower speed is better.  Standing up for yourself was the right thing to do. Now you have a better doctor anyway and are better off.
I ran into a similar type fight when i had cancer. I had a chemo doc who was arrogant and didint want to listen to my arguments when I brought in new research showing better results with a different paradigm than she was used to . She simply wasnt interested in hearing it.   I fired her.   She worked for ME as a doc and I didnt want an arrogant narrow minded doc treating me. The funny thing is she recently saw a patient of mine and was so uncaring and arrogant my patient with cancer left in tears. I worked with the patient to deal with it ,  and she eventually got a phone call from this doctor appolgizing ON A SATURDAY.  So sometime standing up works to smooth things over .
Either way patients need to go in with facts and stand up for themselves. Arrogance by doctors should not be tolerated.

[NDXUFan]

Five years ago I tried to explain the benefit of lower pump speed and increased duration to my nephrologist with the reason being creating less stress on the fistula & heart. He wanted to see proof which I provided buy he did not agree with.

I wanted to increase my time from 3 1/2 hrs to 4 and reduce my pump speed from 450 to 350.

During our discussion he concluded that I will run the short time at the higher speed and started to walk away. I then exclaimed to him in front of everyone that the only reason for doing that was money. He stopped, turned around and was surprised at my comment and stated the he was the doctor and director of the clinic and that is the way it will be.

I received a letter the following week that I need to find a different D center & nephrologist as he is releasing me from his care. The reason being that slavery doesn't exist and he no longer wants to treat me and that he would follow me for the time it would take to make those arrangements.

Currently I have a different center/nephrologist and run 4hr at 350.   

You absolutely did the right thing. The arrogance of some doctors appalls and embarreses me. The research is clear and common sense alone indicates slower speed is better.  Standing up for yourself was the right thing to do. Now you have a better doctor anyway and are better off.
I ran into a similar type fight when i had cancer. I had a chemo doc who was arrogant and didint want to listen to my arguments when I brought in new research showing better results with a different paradigm than she was used to . She simply wasnt interested in hearing it.   I fired her.   She worked for ME as a doc and I didnt want an arrogant narrow minded doc treating me. The funny thing is she recently saw a patient of mine and was so uncaring and arrogant my patient with cancer left in tears. I worked with the patient to deal with it ,  and she eventually got a phone call from this doctor appolgizing ON A SATURDAY.  So sometime standing up works to smooth things over .
Either way patients need to go in with facts and stand up for themselves. Arrogance by doctors should not be tolerated.

NDXUFan: 
Yes, many times, medicine seems to be a field of arrogance and hypocrisy, with dialysis at the very top of the list.  Many of these people do not realize that they have a job because of me.  I decide who treats me, end of discussion....  Many hard and outstanding University science researchers do not agree with the cholesterol theory.  When I point out this fact, many physicans did not want to hear it.  Fine, if you do not want hear the evidence, fine with me. However, I care about my health more than I care about your opinions that are not based in facts.  My brother who is a Ph.D. in Physics and Materials Science(Northwestern) said that there is not enough evidence to validate the cholesterol theory and he said math-wise, that Ancel Keyes study was a bunch of garbage.  It takes a special amount of arrogance to think you know more than a Ph.D. in Physics about math......

[obsidianom]

Five years ago I tried to explain the benefit of lower pump speed and increased duration to my nephrologist with the reason being creating less stress on the fistula & heart. He wanted to see proof which I provided buy he did not agree with.

I wanted to increase my time from 3 1/2 hrs to 4 and reduce my pump speed from 450 to 350.

During our discussion he concluded that I will run the short time at the higher speed and started to walk away. I then exclaimed to him in front of everyone that the only reason for doing that was money. He stopped, turned around and was surprised at my comment and stated the he was the doctor and director of the clinic and that is the way it will be.

I received a letter the following week that I need to find a different D center & nephrologist as he is releasing me from his care. The reason being that slavery doesn't exist and he no longer wants to treat me and that he would follow me for the time it would take to make those arrangements.

Currently I have a different center/nephrologist and run 4hr at 350.   

You absolutely did the right thing. The arrogance of some doctors appalls and embarreses me. The research is clear and common sense alone indicates slower speed is better.  Standing up for yourself was the right thing to do. Now you have a better doctor anyway and are better off.
I ran into a similar type fight when i had cancer. I had a chemo doc who was arrogant and didint want to listen to my arguments when I brought in new research showing better results with a different paradigm than she was used to . She simply wasnt interested in hearing it.   I fired her.   She worked for ME as a doc and I didnt want an arrogant narrow minded doc treating me. The funny thing is she recently saw a patient of mine and was so uncaring and arrogant my patient with cancer left in tears. I worked with the patient to deal with it ,  and she eventually got a phone call from this doctor appolgizing ON A SATURDAY.  So sometime standing up works to smooth things over .
Either way patients need to go in with facts and stand up for themselves. Arrogance by doctors should not be tolerated.

NDXUFan: 
Yes, many times, medicine seems to be a field of arrogance and hypocrisy, with dialysis at the very top of the list.  Many of these people do not realize that they have a job because of me.  I decide who treats me, end of discussion....  Many hard and outstanding University science researchers do not agree with the cholesterol theory.  When I point out this fact, many physicans did not want to hear it.  Fine, if you do not want hear the evidence, fine with me. However, I care about my health more than I care about your opinions that are not based in facts.  My brother who is a Ph.D. in Physics and Materials Science(Northwestern) said that there is not enough evidence to validate the cholesterol theory and he said math-wise, that Ancel Keyes study was a bunch of garbage.  It takes a special amount of arrogance to think you know more than a Ph.D. in Physics about math......
[/quote
Could you explain the cholesterol theory please. What does your brother beleive about it?

[obsidianom]

NDXUfan can you explain cholesterol theory, what you mean by it. I am interested in your brother has to say.

[NDXUFan]

NDXUfan can you explain cholesterol theory, what you mean by it. I am interested in your brother has to say.

NDXUFan: 
My brother stated that Keyes left out many countries where the consumption of fat is much higher and their heart attack rates are much lower than in the United States.  Uffe Ravnskov, Professor of Nephrology and Professor of Clinical Chemistry, Ph.D. in Chemistry said that the more cholesterol you eat, the lower your cholesterol will be....  For example, if you eat very small amounts of cholesterol, your body will make tons of cholesterol to support, brain, nerve function, along with many other body function issues.  For example, when I followed the standard medical diet recommended by the current medical establishment, my cholesterol was at 2,000 and my blood sugar was out of control.  YET, when I followed the eating plan of Dr. Ravnskov, my cholesterol tanked to 50 and my blood sugar was well controlled at an A1C of 5.7 and my last A1C was 5.4.  My primary care/endocrinologist with 34 years of experience stated that people who followed Dr. Ravnskov's advice have very low cholesterol and blood sugar numbers.  Dr. Ravskov and Dr. Kauffman(Below) have said that what is really bad for people is trans-fats, not saturated fat.  What is important for diabetics is to eat many very small meals during the day or night, depending on your schedule.  A great book is "Cholesterol Myths" by Dr. Uffe Ravnskov and Medical Myths by Professor Kauffman. Both books were cheap when I bought them.  I had my dad, retired chemist, brother and my Dad's best friend, Ph.D. in Physical Chemistry review them, they said that they were correct.  They stated when you are looking at any medical treatment, look at the absolute risk numbers, not Relative Risk numbers, they are very inaccurate.   

Professor Emeritus of Organic Chemistry Joel Kauffman, Ph.D. (MIT-1963) 14 drug patents and 100 peer reviewed publications

"A clinical trial result can be published in a peer-reviewed
journal where the results are not statistically significant, yet
claimed to be highly positive.

. Relative risk reduction (RRR) is used to magnify results when
the absolute risk reduction is small. If a drug, test, or device cuts
the subjects with the medical condition from 2 in a million to 1 in
a million, the RRR = 50%. But in such a case, why bother?

 Many clinical trials study mostly or entirely men, but the results
are applied to women as well.

. Subjects in clinical trials may be 40-60 years old to start, but the
results are then applied to those 70-90 years old and children.

. Key findings often are not in the abstracts of the articles
reporting on clinical trials.

. Review papers are often written by drug industry experts to
praise certain drugs.

. Clinical trials are stopped when the data become bad for the
drug, not when the original trial duration planned has been
reached.

. Trials that do not favor the drug are not published or reported to
the FDA.

. Advertisements for drugs ignore FDA warnings on over-promotion.

. Common conditions are elevated to pathological states to sell
drugs.

. Surrogate endpoints (bone density, blood pressure,
cholesterol) are substituted for clinically certain endpoints
(death, cancer, heart problems, ability to walk).

. Internet sites claiming to be patient focus groups are
sponsored by drug companies.

. Continuing Medical Education seminars are produced by drug,
test and device makers to sell their products, not to educate.

. Physicians are wined and dined to favor certain corporate
goals.

. Physicians' prescribing habits can be purchased from
pharmacies to see whether the MDs have responded to sales
pressures.

. The FDA and the NIH are influenced by industry by implanted
employees and consulting agreements.

. Congress is lobbied by the biggest force of any industry to pass
favorable legislation.

. Rare comparison tests between drugs use non-equivalent
doses to favor the sponsor of the trial.

. Ghostwriters are hired to draft papers for medical journals that
will most favor the drug, device, or test.

. Physicians' offices are routinely invaded by "detail women"
bearing biased literature, gifts, and food.

. Treatment guidelines are promulgated by mostly industry
lackeys, and made to seem as though the federal government
has backed the guidelines.

. The direct-to-consumer ads on TV destroy the doctor-patient
relationship.

[NDXUFan]

NDXUfan can you explain cholesterol theory, what you mean by it. I am interested in your brother has to say.

In addition, my brother said there is not enough evidence to support the taking of statins. 

Here is an outstanding paper by Professor Kauffman: 

Misleading Recent Papers on Statin Drugs
in Peer-Reviewed Medical Journals

http://www.jpands.org/vol12no1/kauffman.pdf

Professor Kauffman's bio:

http://www.gradschool.usciences.edu/faculty/kauffman-joel

[jeannea]

You cannot eat cholesterol. I question your theory just based on that.

[NDXUFan]

You cannot eat cholesterol. I question your theory just based on that.

??

[obsidianom]

You cannot eat cholesterol. I question your theory just based on that.

I am not sure what you mean by that. Of course you can. Many foods , in fact most have some amount of cholesterol in them. It is a basic part of biochem of fats in organisms we eat. Why do you think food labels contain amount of cholesterol per serving? It is in what you eat if there is ANY cholesterol,listed on the food you ingest. Virtually all animal fats contain cholesterol, as do many plants. Cholesterol is a necessary component of our bodies and we produce it but also INGEST It.