Your NXSTAGE Therapy or Formula

[alrightstill]

Hi!

Like I said in my introduction post, I've been home on the Nxstage machine since Dec. 04 and LOVING it.. well, the being home part, nothing else.

I'm curious as to what everyone averages per treatment, I know everyone is different, and it there are tons of variables that go into consideration when figuring out the "formula".  Here's my info:

# of days a week:  6
# of NXSTAGE bags:  (3) 5L bags each treatment
Blood Flow Rate:  Lately 410/420
Average UF:  Between .3 - 2. depending
Average treatment time:  2:15/2:25
FF:  28%

I asked my doc if I could maybe go to 5 days a week, he said because of the "formula" I'd probaly having to end up adding at LEAST an extra hour onto each treatment, which sounds ridiculous to me.  Another thing I don't really get, I used to go in center, 3x a week, for 2 hours and 45 minutes each treatment, and my labs were great.  Now I'm doing it daily, for almost 2 and a half hours each treatment, didn't really see a drastic change in my labs, so I dont understand what the big deal would be about doing it 5 days a week?!  Does anyone else do it 5 days a week?

Sorry if a question like this has been posted before.   

[Rerun]

Try the 5 days a week and see what happens.  You can be the test pilot again.

[AlasdairUK]

The time on dialysis is important as it allows bigger particles to leave the blood, but I would think 5 x 2.5 hours a week would be enough with your pump speed of 400+.

Do you feel better now with the extra hours or no difference than in centre?

[alrightstill]

Oh, I definitely feel better now.  I used to go at 5:45am 3 times a week, and my whole day afterwards would be completely shot.  I'd come home and sleep for 6 or 7 hours.  :-/ 

Now, after a treatment, I wouldn't say I feel absolutely normal, but definitely not as tired - and I love the fact that you can drink a little more, since you're removing fluids everyday. 

[Epoman]

Hi!

Like I said in my introduction post, I've been home on the Nxstage machine since Dec. 04 and LOVING it.. well, the being home part, nothing else.

I'm curious as to what everyone averages per treatment, I know everyone is different, and it there are tons of variables that go into consideration when figuring out the "formula".  Here's my info:

# of days a week:  6
# of NXSTAGE bags:  (3) 5L bags each treatment
Blood Flow Rate:  Lately 410/420
Average UF:  Between .3 - 2. depending
Average treatment time:  2:15/2:25

I asked my doc if I could maybe go to 5 days a week, he said because of the "formula" I'd probaly having to end up adding at LEAST an extra hour onto each treatment, which sounds ridiculous to me.  Another thing I don't really get, I used to go in center, 3x a week, for 2 hours and 45 minutes each treatment, and my labs were great.  Now I'm doing it daily, for almost 2 and a half hours each treatment, didn't really see a drastic change in my labs, so I dont understand what the big deal would be about doing it 5 days a week?!  Does anyone else do it 5 days a week?

Sorry if a question like this has been posted before.   

Here is my NxStage formula:

# of days a week:  5 or 6 depending on my plans for the week.
# of NXSTAGE bags:  (4) 5L bags each treatment using either 18 or 20 liters, depending on my schedule.
Blood Flow Rate:  Lately 450/480 even up to 500 sometimes.
Average UF:  Between .3 - 2. average 1.5 kilos
Average treatment time:  2:00/2:45 depends on how many liters used (18 or 20) and my Filtration Fraction.
FF (Filtration Fraction): 30 up to 35

Welcome "alrightstill" glad to have another NxStage user on board. What is your filtration factor? That is what really cuts your time. I use 35 which will cut up to 30 minutes or more off my treatment, simply going from 30 to 35. It doesn't affect your treatment quality it just makes the blood get clean faster. For example, last night I dialyzed with 18 liters a pump speed of 450 and only had to remove .3 kilos, my total treatment time was just exactly 2:01.

I have made all my own changes with my machine but I have notified the doctor. I told them I wanted a 35 FF, I told them about running 20 liters instead of 18. Every treatment I do is different as I adjust many settings depending on my schedule. You need to realize that many doctors don't know as much as they think about the settings of NxStage. In your case if you want to run 5 days I say do it! Give it a try, just make sure you are running  with 18 or 20 liters and increase the FF to 35 (you need to change the machines settings in the bios, which I can walk you through) That should make you run about 2:15 to 2:30 or less.

With NxStage YOU are in control of every aspect of your treatment and you need to learn everything you can about your machine and it's capabilities. And most of all go by how you "FEEL" If you feel fine running 5 days then go for it. I do 5 days some weeks and I have no problems. Again welcome to the site.

BTW. have you checked out http://www.ilovenxstage.com

- Epoman
Owner/Admin

[alrightstill]

Hi Epoman, I was actually learning the machine while my nurses were learning the machine back in 04.  I remember asking about the FF, and it's purpose and not getting a completely full answer.  They were still unsure themselves, as was my doctor.  I guess I just never brought it up again, I remember him always saying "It all depends on the forumla".  Perhaps you can explain the FF to me a bit better, and then I will inquire to them that I would like to change it.  Right now, it's at 28, and it's been steady at 28 since I can remember.

And yes, I too sometimes do 5 days a week and feel great.  Then other weeks I'll do 7 days a week, not even realizing I didn't give myself a day off.     And then there was that one time I went 3 days without a treatment, because I was staying at a friends house in New York and didnt have the means to bring my supplies up there.  All was well, felt great and bloodwork was fine that month.  (Although, I don't recommend going 3 days --- just a little disclaimer. )

Thanks again for the welcome! 

[billable]

This is an old thread, but I actually found it while googling.  Trying to determine the optimal FF.

You may already know all this, but here is the skinny on FF.  Filtration Fraction is better understood if you think of it as Flow Fraction.  It is the ratio of dialysate flow to blood flow going through the filter. On the Nxstage, blood flow is in Milliliters per minute and dialysate is in liters per hour.  If you convert them to the same units you will find that a blood flow rate of 450 and a dialysate rate of 9.0, you have 3 times as much blood flow as dialysate which gives a ratio of 3 to 1 or 33%--or an FF of 33.

We did a little experiment with my wife last week.  We just switched over from the bags to the pureflow unit.  I ran 15L at a FF of 33.  then the next day we ran 18L at a FF of 38.  We drew pre and post on both treatments to run kinetics.  I talked to the nurse last night and the 18L at the faster rate gave a significantly better kt/v than the 15L at FF of 33.  The treatment time was roughly the same.

I am trying to find out what the upper limit of the FF is that is recommended by Nxstage and why?  Since we have to make a batch of 60L at a time and have to use it within 3 days or dispose of it, why wouldn't you just use a minimum of 20L per treatment and speed up the FF to hit your 2 to 2 1/2 hour treatment time?

Well, if anyone has any input on this, I would be interested in seeing it.

[Black]

This is an old thread, but I actually found it while googling.  Trying to determine the optimal FF.

You may already know all this, but here is the skinny on FF.  Filtration Fraction is better understood if you think of it as Flow Fraction.  It is the ratio of dialysate flow to blood flow going through the filter. On the Nxstage, blood flow is in Milliliters per minute and dialysate is in liters per hour.  If you convert them to the same units you will find that a blood flow rate of 450 and a dialysate rate of 9.0, you have 3 times as much blood flow as dialysate which gives a ratio of 3 to 1 or 33%--or an FF of 33.

We did a little experiment with my wife last week.  We just switched over from the bags to the pureflow unit.  I ran 15L at a FF of 33.  then the next day we ran 18L at a FF of 38.  We drew pre and post on both treatments to run kinetics.  I talked to the nurse last night and the 18L at the faster rate gave a significantly better kt/v than the 15L at FF of 33.  The treatment time was roughly the same.

I am trying to find out what the upper limit of the FF is that is recommended by Nxstage and why?  Since we have to make a batch of 60L at a time and have to use it within 3 days or dispose of it, why wouldn't you just use a minimum of 20L per treatment and speed up the FF to hit your 2 to 2 1/2 hour treatment time?

Well, if anyone has any input on this, I would be interested in seeing it.

I wish someone had input on that too.

Mike is running 22.5 liters at FF 30.  I already asked the training nurse about running different numbers and she said it's too soon to change anything yet.  His first dialysis was 2/5/07 and he is doing well.

# of days a week:  6
# of NXSTAGE bags:  PureFlow (two days out of each batch) or (5) 5L bags each treatment
Blood Flow Rate:  500 since third week of dialysis  (nurses LOVE his fistula!!)
Average UF:  highly variable because his PKD kidneys still produce large volumes of clear urine and his diet is very liberal
Average treatment time:   2:55 to 3:15  (Since his current dry weight is 129K that is a very short time for him)
He removes all fluid in the first 2 hours.

[MJB]

Lorelle,

I know that every M.D. is different in their approach. I was larger than your husband when I started on Nxstage. My dry weight was 136K and I did have some function left from my transplant as well. I started at 25L, Bloodflow 550, FF 32 and my typical run time was aroung 2.25 to 2.50 hrs. I was getting great labs with this treatment. Since I started on PureFlow I began a course of 30L, Bloodflow 550 - 600, FF 33 and my run time is right there with your husbands. My labs are awesome.  I have lost almost 75 lbs since then, and I feel much better. I hope that your treatment time don't get much longer. It really is suppised to be Short Daily Home Hemo. Short meaning less then in-center hemo. I'm sure once you get your first labs back there will be an adjustment. Good Luck.

Mike

[Black]

Thanks, Mike.    Congrats on the weight loss    and the good labs.  Yes, we're hoping his prescription will change when we get back from Miami next month and he gets his new labs done.

BTW, his start weight yesterday was 127.6 and his dry weight is 129    (Today we'll probably shoot for 128 as a dry weight - have to wait and see what he weighs today.)  He has felt so much better and has been so much more active I'm sure he has actually lost weight.  Also, his ankles are no longer swollen, so some of it is having gotten rid of excess fluid build up.  Having been at 9% kidney function for about a year left much room for improvement.