Time to Dump the Flow Fraction

[obsidianom]

I was interviewed by some senior staff at Nxstage and they asked for any recommendations I had on their prescriptions. One recommendation I had was to dump the flow fraction forever . I told them it is a confusing concept and basically useless . I think they heard me and basically agreed.
What really matters on Nxstage is number one, the volume of dialysate . That is the most important part of the prescription and really determines how much dialysis you will obtain. The second most important part of the prescription in my opinion is the time on machine. The longer the better. I always try to run the dialysate speed slow enough to get at least 3.25 hours per treatment and some days go for 3.5 hours. This is in line with Dr. Agar's thinking of minimum of 17 hours per week or 10% of total time. (this is at 5 days per week). I dont care what the flow fraction is. I just set the dialysate speed to give me what ever time I decide on .  The only other aspect of the prescription that is important is the blood speed. I will never go over 340 . Again I follow Dr. Agar and what he preaches about slower speeds . He is against going over 350 due to clear evidence increasing speed above 350 causes damage long term to the fistula and heart. There is just no reason ,on Nxstage especially, to go faster. Its the volume of dialysate and time on machine that give the proper clearances , not speeding up the blood.
The flow fraction is irrelevant and we just rest the backround setting on the machine to 100% max. flow fraction (you can even go higher) , so it is no longer a factor at all. I dont even look at it. It is a meaningless number.
I beleive in the future they will probably do away with the whole concept.

One other piece of advice. If you havent checked your presription in awhile , it is a good idea to have your doctor or nurse go to the on line calculator and check the latest. Over the past year or 2 they have upped the recommended volume of dialysate for most people. If your setting is the same as over a year ago it may be too low. It is  easy to have it checked quickly on line to verify it. We started out at 20 liters volume and the new calculator on line recommended 30 liters which we switched to. It is working better for us now.
 In general I dont see how anyone could be below 30 liters now if they do 5 days per week. That is based on my wife only weighing 53 kg and is short and tiny. If she is at 30 liters most of you should be at least at that or significantly more. So check your prescriptions .

[Speedy1wrc]

I brought up the concept of going to a higher dialysate volume with my nurse and she agreed many patients are indeed going for more. I have run the calculator and in think you may have also for me, and I am conforming to the current standard. I would certainly lobby for getting rid of flow fraction. It does not make anything easier. I would much rather just set the numbers I want rather than having to fudge the settings to make the machine work the way I want. I manually create a uf profile and enter the numbers on the fly. Trying to overiride the machine every day is a pain.

When you speak to NxStage again get them to tweak Nx2me so it is a standalone app. Now it requires a piece on the clinic side and DaVita isn't going for it. It is an awesome app that few can use. Also get them to port it to Android.