Fresenius Testing and Binders

[Lupeyleo]

I've been a patient at a Fresenius clinic in St. Louis for the past six months.  My question is why do they do monthly blood work on the third day without dialysis.  I'm Tuesday, Thursday and Saturday.  They do draws on Tuesday before they hook me up to the machine.
Don't you think that extra day without dialysis skews the test?
And another thing I don't like, Fresenius runs the blood work through their own labs.  I'm going to ask unit nurse that I want another lab to test my blood - has anyone else had this problem ?

I was with Davita before I went to Fresenius and never had a problem with iron, phosphorus or potassium since I've been with Fresenius I've had problems.  And yes I've starved myself for three days before the test eating nothing but toast and pasta and the results were still high phosphorus and potassium.  Strange huh.

BTW, I've tried different binders and they make me seriously ill (severe  vomiting, painful cramps and other fun side effects)  I've told them this and they still insist I take  these binders.   Anyone else have this problem?

[RichardMEL]

Agree with you re the Tuesday draw with represents your "worst" situation due to the extra day without D. Maybe that is on purpose since that shows the highest your levels are during the test period.

Our unit does it on a Thursday(for the Tues/Thur/Sat patients) so that it represents what "normal" dialysis is doing for your labs.

I can see both arguments. i suppose what's important is that whatever they decide to do that they are consistent, so that you're comparing apples with apples, and not oranges.

[KICKSTART]

We have monthly bloods done on a dialysis day BUT you must have had 3 full sessions beforehand. We have pre and post bloods done as well.

PS if you want to know about trouble with binders (rather than go into it all here) look for some of my threads , im the worlds worst when it comes to binders ! ..glad im not the only one !  KS.

[RichardMEL]

We do post labs every 3 months. It's only done to calculate the URR (aka clearance).

[Riki]

our bloods are done the first monday and tuesday of the month, monday for the mon/wed/fri crowd and tuesday for the tue/thu/sat crowd.  So, they're always done after the break, and they do pre and post for clearances.  These are everything, all the testing for levels, transplant bloods, and anything else weird that they might want to check.

[Lupeyleo]

thank you everyone who responded.  I still think how they test is wrong and will have this talk with  the nurse.  I start PD at home soon because I've had a couple of bad experiences with some undertrained techs... they're just hiring techs off the street and running them through a crash course of training... isn't that comforting.   I also have a tech that THINKS she's all that and a bag of chips needless to say I've told her different.  I can't wait to start PD at home.

[aharris2]

Agree with you re the Tuesday draw with represents your "worst" situation due to the extra day without D. Maybe that is on purpose since that shows the highest your levels are during the test period.

Yes. It is somewhat inconsistent with the "making the unit's numbers look good" philosophy, so I wonder if Medicare perhaps insists that the testing is done after the 3 day weekend. I am pleased that labs are drawn on Tuesday for us. That way I have a pretty good idea of how high my brother's potassium gets in the worst case scenario (not to mention calcium, and last but not least, phosphorus)

Lupeyleo, eat as you normally would. You need to know how your normal diet affects your blood chemistry. Don't play their game. If you do, they win and you lose.

Knowledge is power.

[Lupeyleo]

Insurance shouldn't matter... I have two private providers.   I still work full time and have to eat.  No eat, no work, no insurance.

I still don't like the idea that they not  only do the dialysis and use their labs to get results... something not right about that.

[Zach]

I dialyze at an independent, non-profit center and they use Spectra Laboratories (the lab that Fresenius purchased), too.
No problems so far.

[Rerun]

I think in the United States Medicare has requirements on labs.  I think they require blood drawn after the weekend and the center has to have "Good Numbers" or Medicare investigates.  (and won't pay)

That is why we have the stupid games to keep our phosphorous low.  It all has to do with getting paid by Medicare.

[RichardMEL]

wow I'm so glad our unit is more interested in our health and well being than making the numbers look good for funding. sheesh.

[Zach]

I think in the United States Medicare has requirements on labs.  I think they require blood drawn after the weekend and the center has to have "Good Numbers" or Medicare investigates.  (and won't pay)

That is why we have the stupid games to keep our phosphorous low.  It all has to do with getting paid by Medicare.

Sorry Rerun, but Medicare doesn't require blood to be drawn that way.
In most cases, sampling on Monday or Tuesday after our 'weekend" would give worst results, not better.

[aharris2]

I think in the United States Medicare has requirements on labs.  I think they require blood drawn after the weekend and the center has to have "Good Numbers" or Medicare investigates.  (and won't pay)

That is why we have the stupid games to keep our phosphorous low.  It all has to do with getting paid by Medicare.

Sorry Rerun, but Medicare doesn't require blood to be drawn that way.
In most cases, sampling on Monday or Tuesday after our 'weekend" would give worst results, not better.

That's actually the point. Checking Monday/Tuesday will give the worst results - the worst case scenario for the patients' blood chemistry and the most informative feedback for the patient. Given the industry's push for good numbers, not healthy patients, as is evidenced by their encouragement to "be good" in the days preceding labs, something or someone else must be driving this choice.

Drawing labs on Monday/Tuesday benefits the patient, not the unit's numbers. It is an anomaly. Why? I am hypothesizing that they are somehow being compelled to do so - Medicare policies would be an obvious choice.

Zach, you are saying that this is not a policy being imposed by Medicare. What is your thought on why the industry draws labs after the 3-day weekend?

[Zach]

Zach, you are saying that this is not a policy being imposed by Medicare. What is your thought on why the industry draws labs after the 3-day weekend?

I'm not sure this is an "industry" thing.  But perhaps one advantage would be with more fluid gain from the "weekend" comes a lower hematocrit, and therefore more EPO is used.

As the new payment bundle begins in January 2011-2012, you might see more labs being drawn on Wednesdays and Thursdays--now that EPO is more of an expense rather than a source of income.

[Hawkeye]

I haven't been on much or posted anything for quite a while but figured I would chime in.  The days your labs are drawn aren't up to the clinic and trying to get the days switched is next to impossible.  The reason for this is with all the thousands of Fresenius clinics out there that use Spectra you also have thousands more hospitals, other dialysis companies and other various types of clinics using them as well.  If all the Fresenius clinics were to be able to do the tests when they wanted the lab would never be able to handle the load.  This has been an on going controversy within Fresenius because the day your labs are drawn do seem to have an impact on the results and the resulting outcomes for the clinic overall.  So some clinics may always look better than they truely are and others may look worse than they truely are all because they got a bad lab draw day.

[Zach]

Good to have you back, Hawkeye!
 

[cookie2008]

I do home hemo and I draw my blood same as the center I go to, the first wed of the month.  The center runs m/w/f.  I was told to make sure I did my treatment the day before I draw my blood.

[Lupeyleo]

Thanks to all for your opinions.  I'm new, less then a year, but from what I have observed, my dialysis unit needs an overhaul and I'll be glad to start home PD soon. Take care to all!