NxStage Calculator

[Hootie]

How do we get the NxStage calculator? Last time I went there they want medical person's credentials. I would like to see what the treatment times and Dialysate amounts would be for my wife when we cannot do 5 days on the NxStage machine. Occasionally, due to scheduling we can only do 4 days. She uses 25 Liters per treatment five days a week. We usually pull about 1.5-2.3 (depends on last treatment) on average UF at about 2:30-2:45 hours and a little longer is if the pull number is higher. FF 50.

She feels fine and the KT/V values are typically 2.3-2.6.

[Simon Dog]

Try signing up using license #1 and license type of "Other" and see if that works.  Or, use your driver's license number and "other" and you would be telling the truth 

[obsidianom]

How do we get the NxStage calculator? Last time I went there they want medical person's credentials. I would like to see what the treatment times and Dialysate amounts would be for my wife when we cannot do 5 days on the NxStage machine. Occasionally, due to scheduling we can only do 4 days. She uses 25 Liters per treatment five days a week. We usually pull about 1.5-2.3 (depends on last treatment) on average UF at about 2:30-2:45 hours and a little longer is if the pull number is higher. FF 50.

She feels fine and the KT/V values are typically 2.3-2.6.

actually I think you are too low in your dialysate volume and Kt/V  (which is a joke anyway but since we use it I will mention it. )  I don't believe ANYONE should use less then 30 liters dialysate unless they dialyze 7 days per week. 30 liters is really the LOW limit for 5 days per week. That is what I run my very tiny wife (51 kg weight).  Also I want a kt/v of at least 3.0 on Nxstage . We get 3.1 usually on 30 liters daily   .  Nxstage already uses small amounts dialysate but below 30 is just plain too low for good dialysis.  30 works well also on a 60 liter sak as you se half the sak each time.   

[Simon Dog]

I was told my Kt/V of 2.0 was fine on NxStage @ 30L, but I told the RN I did not want to be at the edge.  She moved me up to 40L and I'm at 2.5.    Since I use 40L of a 50L sak, I have 10L left over.  I'm going on nocturnal in two weeks, and expect to be on the full 50L and have been told to expect 3.0.    I'll be asking the RN to move me to 60L and change the sak (I use a 40lactate/50L sak) to 60L which should give me a bit more.

The local RN is fantastic, however, I still feel I have to push a little bit to make sure I am not merely getting "adequate" dialysis.

[Hootie]

In response to Obsidianom's note, we were pushing toward 30 L typically doing 29-29.5 liters per day for about over a month. We were trying to max the 60L bag and thought more cleaning the better per what we learned here. Got the KT/V up to 2.89 and felt pretty good about it, but my wife started having some heart pain at end of the third day in one session. That was on a day where the BP was fine. Nephrologist asked us to pull a whole bunch of labs out side of the monthly ones. Labs indicated that PTH, anemia, low salt  and K levels too low and basically the electrolytes out of balance. 

 Nephrologist said we were over doing it and asked us to drop back to 25L per treatment and do 2 on, 1 off, 2 on 1 off rather than doing three days straight. She said my wife was too clean and out of balance. There were times during that month where we did have to bolus several times to keep blood pressure from bottoming out. She said that contributed to the out of balance too.  Since we dropped back to 25L there have not been any real issues. We are still doing three on and one off and then doing two. I wanted to use the calculator to raise the dialysate volume and rate so we could figure out what to do on those occasional weeks when scheduling only permits 4 days a week due to travel or other issues and keep her clean.

On a separate issue, we have found that if we use the 1.0 UF rate all the way through treatment (assuming we need to take 2.0+ UF off) , then there is a great chance of a BP issue in end. However, if we start with 1.0 UF rate then drop it to .6 or .7 after her BP drops to 110 or so, then BP goes back up slightly and we raise it back to 1.0. We have done that 4-5 times and it seems to work by slowing the pulling down and the second half of treatment. Do you guys see that happening with yours?

Joe

[Simon Dog]

However, if we start with 1.0 UF rate then drop it to .6 or .7 after

I always calculate the minimum UF necessary to take off the desired amount, but never go below .30 UF (RN's instructions).   I find that if I max out my System 1 at 12L/hour, a UF rate of .69 is the maximum possible for a 2.0L removal, which is the max I do during a treatment (frequently less).

I wanted to use the calculator to raise the dialysate volume and rate so we could figure out what to do on those occasional weeks when scheduling only permits 4 days a week due to travel or other issues and keep her clean.

Ask your RN for an alternate 4 day dosage schedule - (s)he will probably be glad to help.   The "system" frowns on self-adjustment of RX parameters, even if the patient is competent to do so.

[Hootie]

An update....and concern....based on reading at home dialysis central regarding writings by Dr Ager, we decided to max out at .7 UF rate. Appears to be better that starting at 1.0 and rat hinge it down when BP drops. It does cause for a long term on machine.....

Even before that, we have had issues taking off the UF volume the machine says it has been taking off......machine was replaced several months ago and still having same issues. Today we were on for 3:39 and machine says we took off 2.3 weight says 1.6. No eating nor drinking...

Thoughts? It's inconsistent.

[cassandra]

Just a small question, are your scales in the same place pre and post? I can loose a kilo when I move the scales 15 cm or so (wooden floor)

Good luck and love, Cas

[PrimeTimer]

The reading we get from the cycler for total UF removed never quite matches our scale 100% but is fairly close.  If I remember correctly, NxStage said that the numbers might not always perfectly match but should be within a certain margin. Sorry, don't remember what the margin is. Maybe give them a call and give them your numbers and they will check for you. 

My husband is pretty consistent with his treatments. He either removes 1.5 or 2.0.
When he needs to remove 1.5 kilos, he runs at a UF removal rate of 0.50 per hour for a total of 3:30 hours (with all the system "2" checks, ends up being a total of 3:32).
When he needs to remove 2.0 kilos, he runs at a UF removal rate of 0.64 per hour for a total of 3:30 hours (with all the system "2" checks, ends up being a total of 3:36).
 
He uses a Flow Fraction of 40 and 30 liters of dialysate per treatment (60L SAKs). He does 5x a week (3 on 1 off, 2 on 1 off, 3 on 1 off...) Maybe according to the calculator he is technically underdialyzing but he feels great, works a full-time semi-physical job, his Neph is happy with his numbers or as the dietician just said, "labs look fabulous".

[Vt Big Rig]

I have had incidents where the machine was set at 1 and it only took 0.5 off. Almost always weight shows 0.1 or 0.2 less is taken off than machine says.

Every time I try to adjust for that and set it for 0.1 more .... it takes off the exact amount.

NxStage will tell you "that is in spec"

[Simon Dog]

He uses a Flow Fraction of 40 and 30 liters of dialysate per treatment (60L SAKs). He does 5x a week (3 on 1 off, 2 on 1 off, 3 on 1 off...) Maybe according to the calculator he is technically underdialyzing but he feels great, works a full-time semi-physical job, his Neph is happy with his numbers or as the dietician just said, "labs look fabulous".

I had a near-identical Rx and was getting marginal dialysis numbers (Kt/V 2.00).   I pushed for a "better" Rx, and I am now using 40L running at full speed (12L/hr) on the System 1 and get a Kt/V of 2.50 in the same time.  The disadvantage is that if you use a 40lactate solution, the closest sak size is 50L (though they do make a 40L sak for the 45 lactate concentration).

You may wish to ask about more dialysate, faster, in the same amount of time to improve your numbers.

[Hootie]

Cassandra,
You appear to be right with the answer regarding scales changing on the wooden floor. We placed something under the scales and do not move it. We have been pretty stable on the take off of UF volume since then.

[cassandra]

I'm glad to hear we got that sorted    Hootie

Lots of love, Cas