NxStage

[big777bill]

 

[cassandra]

So Bill, did you get to see it?

Love, Cas

[big777bill]

 Cas I now (finally) have the new Stage One S in my possession. It will only work as a high flow unit with a pureflow, which I didn't have before. Now I'm waiting on the lab at Davita to give me the OK on the samples of water and dialysate sent to them yesterday. With some luck I will use it for the 1st time on Monday but we have an enormous snow storm coming our way. It is supposed to hit on Sunday night until Monday evening leaving us with 10 to 14 inches. My dialysis RN wants to be here when we use it the 1st time. She very well may have a hard time gettting here.   

[cassandra]

   

Glad you've got the machine anyway, and it will probably work out fine   

Let us know how you get on.

Love, Cas

[obsidianom]

Does the machine look any different than the regular cycler? Any differences in the operation?
We just had our well and water retested for our annual test . 

[big777bill]

 It looks almost exactly the same. The only difference that I see is the logo "System One S". The dialysate pump can handle higher capacities. My clinic RN told me I would be running at a flow fraction in the mid sixties and using 60 liters of dialysate per treatment. Now I run at a flow fraction of 27 with 30 liters of dialysate. Currently I'm on the machine about 4 hours daily X 5 days a week. With the high flow it will be 3 hours 15 minutes every other day. If that doesn't work out I'll go to 4 days weekly. I heard that by this summer all NxStage machines will be high flow whether you use them as one or not. The old System One machine will be discontinued. Time will tell.

[obsidianom]

So you are planning on doubling the amount or volume of dialysate from 30 to 60. That should be interesting . I would be interested in how you feel physically  doing that.  What is your blood speed and dialysate speed now, and what do you plan on them being on the new settings?   You will be making up a new batch of dialysate on the pureflow after each treatment . You can expect the PAK life to be short also.

[big777bill]

 My blood speed was 500 and is the same now that I'm using the high flow. Dialysate speed is 17.5 L/HR until fluid is removed then it goes to 18 L/HR. I've only done 2 treatments so far but I feel good afterwards.The old dialysate speed was 7.1 L/hr while removing fluid then it increased to 8.1 L/hr. I hope that is what you were looking for.

[cassandra]

Why is your blood speed so high?

Love, Cas

[big777bill]

 Cas that is where my neph wants it so I'm compliant to her wishes. I know about how they say to run at a slower rate is easier on your heart and fistula. I have been running at 500 for 2 years now with no problems at all. I don't know if size has anything to do with it but I'm 127 kilos and 75 inches tall.

[obsidianom]

Size has no real effect on blood speed. The problem with your speed is longterm damage to the fistula and heart. Two years isnt that long yet. 
Dr. Agar who runs the nephro program  in a whole province in Australia and is a world renouned nephro. is really down on our blood speeds in th US.  He runs his patients at about 220 to 250 and the data on fistula damage and other vascular events is clear. He sees far fewer interventions on fistulas and cardiac damage.
You can ask your nephro about changing. She may be amenable to it  .   Ours lets us run at any reasonable speed. WE do 340  on Nxstage. It would be hard with the limited hours we do (3 hours per treatment) to go much slower and still get good clearance.  In Australis they do much longer dialysis.

[big777bill]

  My main concern is that I'm on the machine so long now that I hate to add any more time to treatment. I suppose that nocturnal would be the way to go. I'm a very restless sleeper, always moving, turning and swinging my arms. My wife hates it. It would make it hard to do dialysis that way. It's always something,lol. I'm only 58 years old now so it would definitely be in my best interest to make dialysis as easy as possible on my body. It is so hard to keep up with everything. I had a liver transplant in 2005. Since then it seemed like everything went downhill. My diabetes which was being treated with pills is now being treated with insulin. The imunosuppressants. they gave my for the liver transplant damaged my kidneys to the point of where dialysis is my only option. I am not a candidate for a kidney transplant. I still have the hep-C which is what started this whole thing. I've been treated 4 times for the hep-c with no luck. Only one time post transplant. It was after that treatment that my kidneys really started to go downhill. I'm not sure if the treatment had anything to do with it or if it's a coincidence. My liver Dr. told me the other day that a new, gentler treatment is available now but it still needs to be approved for dialysis patients. Let us hope for a quick approval.

[obsidianom]

  My main concern is that I'm on the machine so long now that I hate to add any more time to treatment. I suppose that nocturnal would be the way to go. I'm a very restless sleeper, always moving, turning and swinging my arms. My wife hates it. It would make it hard to do dialysis that way. It's always something,lol. I'm only 58 years old now so it would definitely be in my best interest to make dialysis as easy as possible on my body. It is so hard to keep up with everything. I had a liver transplant in 2005. Since then it seemed like everything went downhill. My diabetes which was being treated with pills is now being treated with insulin. The imunosuppressants. they gave my for the liver transplant damaged my kidneys to the point of where dialysis is my only option. I am not a candidate for a kidney transplant. I still have the hep-C which is what started this whole thing. I've been treated 4 times for the hep-c with no luck. Only one time post transplant. It was after that treatment that my kidneys really started to go downhill. I'm not sure if the treatment had anything to do with it or if it's a coincidence. My liver Dr. told me the other day that a new, gentler treatment is available now but it still needs to be approved for dialysis patients. Let us hope for a quick approval.

You can increase the flow fraction to speed up the dialysate up to a maximum of 12 liters per hour on the regular Nxstage cycler. It is really the dialysate speed that determines time on machine, not the blood speed.
What do you run for a dialysate speed now?     How much dialysate do you use per treatment?
WE run about 10 liters per hour for 3 hours to do 30 liters per treatment.

[big777bill]

Obsidianom I use 60 liters over 3 hours 20 min.

[obsidianom]

Obsidianom I use 60 liters over 3 hours 20 min.

Based on that, you are running at a dialysate speed of 18 liters per hour. Is that correct?  You must have the new high speed machine.
What is your weight, height and hematocrit? How many days per week do you dialyze?

[big777bill]

 Yes I have the new high-flow cycler. I've had it for 3 weeks now. We've only been using it since last Tuesday Actually that is how this thread got started. 18 liters per hour is correct. I'm 127 kilos and 6ft 3in. My hemocrit is 32 but that was from labs taken before using the high-flow. For now we are going every other day, M,W,F,Sun. this week and Tu,TH,SA next week. My neph told me she wants me to go to 4 days a week if my next labs aren't where she wants them.

[ianch]

Wow 500 QB is fast. We are trained in NZ to not exceed 250 for home.  My testing over 6 months showed that 10hrs and 225 had the lowest side effects for me. 
I tried 250 but there was a noticeable metabolic effect that affected concentration.   I have a high pressure IT consultant role in finance so need all brain cells firing. 

My bloods inproved by 30% with my plan and many indicators are with in normal levels despite no meds.

while id love the portability of nxstage, no doctor here will reccomend it for ongoing use.  I could buy one privately but at 30k its not valuable just for holidays alone.  I dont care about how big my machine is, but rather that it gives me the ability to smash life expectancy and get the 25 years im looking for.  Thats why I personally follow best practice, so I can see my daughter grow up.

[obsidianom]

Yes I have the new high-flow cycler. I've had it for 3 weeks now. We've only been using it since last Tuesday Actually that is how this thread got started. 18 liters per hour is correct. I'm 127 kilos and 6ft 3in. My hemocrit is 32 but that was from labs taken before using the high-flow. For now we are going every other day, M,W,F,Sun. this week and Tu,TH,SA next week. My neph told me she wants me to go to 4 days a week if my next labs aren't where she wants them.

I have an opinion , but remember it is just an opinion from someone who doesnt know you . Talk to your nephro before changing any thing.
I beleive you are not getting good dialysis with your current regimen.  I ran your numbers and you really outside Nxstage recommendations . With your size you should be at minumum of 4 days per week.  With the additional dialysis added you could slow down the blood speed to 400 or even 350 which is far safer. Yes it would SLIGHTLY add time  but that is better anyway.  Going down to 400 would give you about 3:40 time on machine which is only 20 minutes longer than you do now. If you go to a really good 350 it would be 3:50.   That only adds afew more minutes to save your fistula in the long run.
Also more time on machine is better for health.
So by going from 3.5 days per week current to 4 days per week you will get better dialysis and be able to slow down the blood speed to safer levels. You are pushing Nxstage now outside its recommended parameters. That  may be why your labs arent as good as can be. My wife gets KT/V of 3.2 on Nxstage. Yours may be down to under 2 currently.  You are large so you cant really do so little dialysis . You are trying to make up for it by speeding up the blood to very fast speed.
In my opinion again you are risking your health in th long run.
If you are adamant about only every other day, than perhaps the regular Fresenius machine might be better for you. It allows every other day. Nxstage relly is made for 4 to 6 days per week for large patients especially.

[big777bill]

 We go to kidney clinic next week. I will bring up the recomendations you gave me . The last kt/v was 2.88 and that was the highest I've had this year. They have all been over 2 but some not by much (2.11). I thought that we would probably have to go to 4 days but my wife is my caregiver and she has had a very hectic schedule. She is a pediatric home care nurse. We've been talking about trying to work it out so she can be home with me all the time. At worst she can retire in Sept. Thanks for your interest and any suggestions you have are always welcome.

[obsidianom]

I think the reason you upped your KT//v recently was you upped your dialysate speed to 18 with the new machine. The problem is that to get it that high KT/V you raised the dialysate to 60 from a lower number before and more importantly you are running a huge amount of blood through at 500  speed. The probelm there is you are risking your heart and fistula if you keep doing that . In a way you are artificially increasing the KT/V  by raising the blood speed out of normal safe parameters.   
I understand your issue with your wife. So perhaps the Fresenius system which is designed for fewer days of dialysis at home is better for you. I love Nxstage but it does take more days on then regular dialysis. It is gentler normally at lower blood speeds.

WE just got my wifes KT/V and it is up to 3.24 doing 5 days per week, 30 liters and a blood speed of 340.