Thinking of swiching to NxStage from Baby K

[Simon Dog]

I am currently doing home hemo using the Baby K on an every other day schedule (4 hours, F180NR filter, 103kg dry weight).   I am considering switching to NxStage and am interested in comments from those who have been there/done that.     My wife wants NxStage since we had a couple of incidents where I lost a setup worth of blood (the issue that caused that has been successfully addressed) and she it terrified I am going to kill myself by accident.    I doubt that will happen - the BabyK has a lot of safeguards, and the worst thing that can happen seems to be loss of a setup worth of blood and the associated drop in HGB.

So, comment and advise away.

[obsidianom]

I am currently doing home hemo using the Baby K on an every other day schedule (4 hours, F180NR filter, 103kg dry weight).   I am considering switching to NxStage and am interested in comments from those who have been there/done that.     My wife wants NxStage since we had a couple of incidents where I lost a setup worth of blood (the issue that caused that has been successfully addressed) and she it terrified I am going to kill myself by accident.    I doubt that will happen - the BabyK has a lot of safeguards, and the worst thing that can happen seems to be loss of a setup worth of blood and the associated drop in HGB.

So, command and advise away.

Yesterday the nurse at our clinic was raving about Nxstage. She just trained 2 new people on it and they already are telling her how much better they feel then when on the conventional Fresenius machine. This is typical of what happens when you switch to 5 days on NxStage compared to 3 or 4 days on Baby k. She wants to get all her patients to try it now in center a s a demo to try to show them how much better they will feel on NxStage.  This is a Fresenius clinic and they fought me when I was the first to get Nxstage for my wife a year and a half ago. Now they are beleivers.   
Nxstrage is a volume based system . You dialyze by set amount of dialysate vulume and the time can be variable based on the speed you run the dialysate. Some days we run fast if in a hurry and others we go slow . WE can save a half hour or more by speeding it up. Generally we go 3 hours , 5 days per week using 30 liters of dialysate. My wife gets 15 hours of dialysis rahter then the 10.5 she got in center. This is a life saving differance. More time means better quality and is healthier for all the body systems.  Also 5 days is so much better than 3 and still better than 4. you can even choose to go 6 days. 4 days is an option too but most people do 5 days.
The extra days put far less stress on the heart and circulatory system. It reduces left ventricular hypertrophy.  In the words of Goerge Bush, "it is a kinder , gentler " dialysis. My wife used to get headaches and feel ill on dialysis. On Nxstage she actually feels BETTER each treatment and after . She looks forward to dialysis rather then hates it.  I see such a differance as do the nephrologists and nurses.
AS a doctor and care partner I am sold on Nxstage as a far superior type dialysis medically and in ease of use.  It is so easy to set up and break down after. It takes under a half hour to set up (about 20 minutes), and 5 minutes after. Everything is disposable so there is little cleaning and maintenance. It uses less water then the Baby K and no electrical issues. We just plug 2 plugs in the wall oulet.  It runs itself and almost never alarms. I forget its on most of the 3 hours.
Training would take a few days if you already do home dialysis. You will find it very easy to learn. It takes up less room in the house and IS PORTABLE if you want to travel with it. There are bags of pre mixed dialysate for that. The pureflow makes its own dialysate for daily use. Its a cool machine .
If you have any questions you can post or send me a private message. I would be happy to help. I grew up in Boston but no longer live in Mass. My mother still is there .
It is unusual to lose a set up of blood on Nxstage.  You can manually squeeze it back in an emergency.
Dr. O.
 

[RenalSurvivorDotCA]

I had a couple of incidents where my line clotted and I couldn't return my blood. I was told with the BabyK and the tubing set used that the blood outside the body at any time was 200-300ml; much less than when you donate blood. Since then, I was never worried about not returning blood; e.g. say in event of a power outage or emergency.

LOL. I remember one unit I was visiting had a small pair of scissors and 4 clamps in a baggie hanging on the pole. It was an emergency off kit. Just clamp, clamp artie, clamp, clamp venous and snip, snip and outta there. Nevermind the alarms. LOL

[Simon Dog]

I don't know the amount of blood in the tubing and arterial/venous chambers, however, the filters are marked with the priming volume - 98ml in the case of the F180NR filter.

[cassandra]

I've lost quite a few of setup worth of blood on the Nxstage too though. The problem is me, myself, and I so that will never change. If you are doing eod 4 hours you are still doing 14 hours which is only 3,5 hours less than I do in a week on Nxstage  (5 hours eod (in case I made a calcu mistake )  So that's doable on Baby K too(?)

I only wanted Nxstage so I could D abroad with my own machine, and that I didn't need to change the house with the plumbing , and electricity. You have that already. Maybe you want to ask yourself, and your wife, why the change?

Love, Cas

[cassandra]

Forgot to mention that I used to do 5 days 2,5 hours for a year, and a bit. I feel better on this regime, mainly cos less time per week setting up/breaking up, and way more blood litres processed   

[Simon Dog]

I only wanted Nxstage so I could D abroad with my own machine, and that I didn't need to change the house with the plumbing , and electricity. You have that already. Maybe you want to ask yourself, and your wife, why the change?

Spoke to my doc yesterday.  He told me that I would be a 6day/week NxStage person, but he really felt that BabyK was better as long as I continued to do it the way I am (i.e., not switch to a standard 3 day schedule).   I work full time and losing those two extra nights off would be a big impact on my life, so I am following his advice.  He also feels reduced wear on the access is a big benefit of sticking to 4 rather than 6x/week.  Now, all I have to do is have him get the nocturnal logistics in place .

NxStage gets rave reviews and has a cult-like following, but I guess there is no one system that is right for everyone.

[obsidianom]

6 days per week is a bit rough . We tried it and found it hard. So if you need 6 days then you are probably better off where you are. I'm not sure why you need 6 days but since your own nephrologist knows you and I dont, you have to go with what he says. In the end it is still time on machine that matters. Going nocturnal will help that a lot. Good luck.

[Simon Dog]

6 days had to do with a couple of things - my EDW is 103kg, and I currently do 4 days with the BabyK, so my doc was telling me what he thought it would take to get an equivalent treatment.  He knows I am not interested in "just meets guidelines", which is why I am not on 3 day BabyK.

The big issue with FMC is "remote monitoring" - a requirement for nocturnal.  I keep getting "we're looking into it".   I know they have the tech since I believe it is required by law for all home D patients in NY.   If this keeps up much longer, I'm going to start asking questions like "If I were on nocturnal, what blood/dialysate flow rate would you prescribe, and what heparing bolus/drip would you order?  "

[Simon Dog]

It looks like I am moving to NxStage.   I collapsed after a BabyK treatment and convulsed a bit.  My care partner is concerned, so I will switch to NxStage it possible. 

My thanks to all who contributed to this thread and convinced me that this is a viable, and good, option.

[obsidianom]

Do you know why you collapsed?  Was it low BP from too much fluid taken off? Or something else?
Good luck with the change over. Dont hesitate to ask for any help with the switch. We are all here to help . I think you will find Nxstage much easier to use and hopefully will be smooth sailing.

[Simon Dog]

Do you know why you collapsed?  Was it low BP from too much fluid taken off? Or something else?
Good luck with the change over. Dont hesitate to ask for any help with the switch. We are all here to help . I think you will find Nxstage much easier to use and hopefully will be smooth sailing.

I was taking 3L off.  I usually take 1.8-2.2 off, but there was a machine issue that stretched this out to a 2 day gap hence more fluid.  I had a BAD cramp, stood up too quickly, blood pressure dropped then I did.   I could care less about "easy to use", but I am looking forward to the new protocol.