new machines are making me crash

[sullidog]

Our dialysis center got new machines. We went from backster to now fersenious machines. The problem is the new machines work harder and there for I'm crashing. I have no UF because I don't gain fluid, it just pulls the minium. I still crash and have to eat ice on the machine just to make it through a whole treatment, then when I get home I get sick, not dizzy, just sick. I made this aware to my staff and they are going to try a smaller dialyzer because they say I may be clearing too quickly? They say that backster was just a bandade type machine and doesn't work as well as these. Do you think a smaller dialyzer is enough? or is there something else that needs adjusted.

[KICKSTART]

Which Fresenious machine is it ?  I dont know about the Baxter machines, but the new one you are on may be the type that does HDF as opposed to the older type which just do HD. When i started on hemo we have all the latest machines and ours do HDF, which is more aggressive , i was sick all the time. Then one of the nurses said she had seen this happen before when they changed from the old machines to the new ones, so they set mine to just do HD and pretty much since then ive been a lot better. It might be worth finding out if you are now on HDF.

[boswife]

 curious........ HDF???

[Des]

Oh yeah! I can answer this one.

I moved from HD to the new HDF machines.

It is the Ferarri of the dialysis machines and it is currently the best in the business. It is called Hemo Dialysis Filtration.
1. it uses tap water (which it sterelises before it uses it) not saline bags
2. it filters out more. HD can filter molecules up to a certain size but HDF filters a lot more out. The long term illnesses associated with kidney disease are a thing of the past as this machine takes care of those. Like renal artheritise (sorry about the spelling) calcification of arteries ect.
3. Because it is so good it has one downside - it removes vitamins and too much potassium and other needed goodies out as well. So you do need to ask the doc to give you a multivitamin and in my case I now have to add 2 potassium tablets everyday as it removes too much potassium and then I get heart palpitations. 
4. When you work out how much fluid to remove you must realise that it reinfuses less fluid than the HD machines. They must account for this.
5. Ask them to use postfiltration as this makes the treatment more "mild' on the body and you dont crash as much.
6. In fact it is proven to be better as it does not make your blood pressure drop - it automatically adjusts it.


I asked them in the beginning to alternate between HD and HDF untill I was used to it. Believe me the other day the HDF did not work and I did a HD by accident and I felt worse afterwards for 2 days.

Don't go back to HD please, hang in there it will get better once the staff gets used to the new settings.
Good luck.   

[KICKSTART]

  excellent description Des ! One or 2 points though , it IS supposed to give better overall D but i found my labs havent changed really by going backwards and using HD. My body couldnt tolerate HDF so it really doesnt suit everyone. Quite a few people find it very aggressive .

[boswife]

great info!!! thanks for taking the time to help us out here 

[Bill Peckham]

It's hemodiafiltration. Sullidog - what's your pre/post weight/blood pressure?

It sounds like a fluid problem, not a solute problem.

[sullidog]

I've never heard of that term, but I have now! My bp usually ranges in the 130's but when I start to crash one day it went down to 113 over 80 and one day the top was 125 which is still in normal range and not crash range. My wait is 53 and both post and pre. They give me flushes every half hour.

[Bill Peckham]

I just can't see how the additional solute removal would cause 'crash' symptoms.

Typically I would call having low blood pressure crashing - and that is almost always a fluid issue. It sounds like your unit is right on top of things with regard to fluid. You say you have headaches post treatment - that to me sounds like it could be an issue with the sodium and /or conductivity of the dialysate.

I attended the Annual Dialysis Conference last month and heard a talk by Andrew Davenport, MD. He presented data that dialysate sodium varies greatly and is often not what is expected. The machines say one thing but independent testing reveals the machine's lack of accuracy. There were huge and frequent variations measured. I'd ask if the dialysate delivered by the machine has been tested independently in a robust way to confirm the proper sodium is being delivered.

[tyefly]

I know there are some people who dont do well with the filters.... they are allergic ....   they have other filiters for those people....  ask about those....   

[billmoria]

I use a F 5000  and it is very aggressive. If it takes off too much liquid (and that could be it) drink something during D. I always have liquid to take off and it frequently took off to much in the beginning.
You can learn to read the machine and if you dialysis staff shows you (and allows you - I really don't understand the ones that do not) you can makes changes as you do your D.
HDF is superior to HD but some people on our shift stick to HD for reasons that sound much like yours.

I hope you do better