cleaning concerns

[fuzzyL]

every month my labs for cleaning are about 1.9 for home hemo and the clinic wants them over 2.--we were cleaning about 80 liters per day-so we increased the flow factor and the speed to clean 97 liters per day which is an increase of over 256 liters per month--yet the labs were the same --the clinics solution is to do an extra day per week but since we increased the amount-is not that the same affect??

[Hemodoc]

You didn't state what your total volume is. NxStage has WAY too little dialysate in my opinion and future home machines will be essentially at the same level as in-center machines. You can go into the NxStage website and calculate a better dosage on their calculator. My take is to bring it to the highest volume possible because more is always better.

You also did not give an indication of total time per session or frequency. With NxStage, you MUST have a minimum of 4 treatments a week. The clearances on this machine are at abest 2/3's of in-center machines. Further, blood flow rates are quite important as well as FF.

Bottom line, increased volume is usually the best place to start and increased frequency is obviously another choice, but I always wanted to make the TIME on dialysis used in the most efficient manner with the highest volume possible.

[obsidianom]

every month my labs for cleaning are about 1.9 for home hemo and the clinic wants them over 2.--we were cleaning about 80 liters per day-so we increased the flow factor and the speed to clean 97 liters per day which is an increase of over 256 liters per month--yet the labs were the same --the clinics solution is to do an extra day per week but since we increased the amount-is not that the same affect??

You seem to be focusing on the wrong thing. You are writing about "cleaning" 80 liters per day. I assume that is the blood volume. That isn't really the most important item. Unlike the big machines the blood volume on Nxstage is far less important then the DIALYSATE volume. The only way to really improve your numbers is MORE DIALYSATE and as HEMODOC wrote , at least 5 days per week.     How much dialysate are you running? How many days?  How much do you weigh and how tall. ?

[fuzzyL]

I will get back to you with more info--for now I can say we do it 4 days a week for 4 hours a day-Ill get more specifcs

[Maggie and Jeff]

Maggie is running near 3.0 or 2.9 kt/v.

Do post back there are many here that want to help

[fuzzyL]

I am male--5 ft. 8 inches--about 102kg--flow fracture=35-we use 30 liters of dialysate a session-we circulate 480ml min for 97 liters cleaning a session for about 4 hours a day-4 days week-we have changed the time and flow rates more than once in the two years plus of home dialysis yet we always come just short of the clinic cleaning requirements

[Hemodoc]

I am male--5 ft. 8 inches--about 102kg--flow fracture=35-we use 30 liters of dialysate a session-we circulate 480ml min for 97 liters cleaning a session for about 4 hours a day-4 days week-we have changed the time and flow rates more than once in the two years plus of home dialysis yet we always come just short of the clinic cleaning requirements

Quite simply, at 102 Kg, you need a higher volume of dialysate. I would recommend you go to the NxStage "calculator" and see how well you would do with 60 liters. There will be no improvement until you get a higher dosage of dialysate. That is the Achile's Heel of NxStage.

[obsidianom]

I am male--5 ft. 8 inches--about 102kg--flow fracture=35-we use 30 liters of dialysate a session-we circulate 480ml min for 97 liters cleaning a session for about 4 hours a day-4 days week-we have changed the time and flow rates more than once in the two years plus of home dialysis yet we always come just short of the clinic cleaning requirements

I agree with Hemodoc.  You are using less total dialysate in a week then my tiny 55 kg wife. Changing the rates is like rearranging the deck chairs on the Titanic, it is useless. You need a much higher volume . Period. 

I checked the on line calculator and suffice it to say you are WAY below the recommended dialysate volume.  There is  no way you will ever reach a decent clearance with your current paramaters.

[PrimeTimer]

I am male--5 ft. 8 inches--about 102kg--flow fracture=35-we use 30 liters of dialysate a session-we circulate 480ml min for 97 liters cleaning a session for about 4 hours a day-4 days week-we have changed the time and flow rates more than once in the two years plus of home dialysis yet we always come just short of the clinic cleaning requirements

My husband is slightly taller than you but about the same weight -we do 30 liter treatments at a flow fraction of 40 at a blood flow rate of 360-380 for 3:30 hours x5 times a week. (we do 3 days on, 1 day off, then 2 days on, 1 day off, then 3 days on...etc...or what we call the "3-1-2-1" schedule). At the end of each treatment, the cycler says BLP (blood liters processed) was 79-80. He probably should be using 40-60 liters of dialysate but his labs have been very good, he feels good and works fulltime so his Neph hasn't increased his volume. His wstd/Kt/V and stdKt/V are consistently well over 2.0 every month. Maybe if you were to do at least 5 days a week instead of just 4, you will get better results. And aside from your lab results, pay attention to how you feel and your energy level. It may not sound like much of a difference but my husband actually feels a difference and feels better doing 3:30 hour treatments opposed to shorter 3:15 hour ones. Good luck.

Wanted to add that since no two people are exactly alike, their lab results will vary from each other. I'm sure it all depends on a persons health and other medical conditions they may have and medications they take. Every case is different. The good thing is that you are trying to improve. Keep up the good work, it will pay off!

[fuzzyL]

thank you all for helpful advice!!!!!  brings up another question for primetimer-how does your husband have time to do that 5 times a week and work full time??  it would seem he would have very little free time or time to do projects or whatever around the house_ I do dialysis to live but doesn't seem to be much time for living between that and working-I don't ask to be a jerk, hard to pay bills on disability so I have considered returning to the work force

[PrimeTimer]

thank you all for helpful advice!!!!!  brings up another question for primetimer-how does your husband have time to do that 5 times a week and work full time??  it would seem he would have very little free time or time to do projects or whatever around the house_ I do dialysis to live but doesn't seem to be much time for living between that and working-I don't ask to be a jerk, hard to pay bills on disability so I have considered returning to the work force

We do his treatments in the evening when he gets home from work. We are up very late so no, we don't get to do much else but we do get 2 days off (never 2 days off in a row from treatment tho). Part of the reason we are up so late is because we wait 2 hours until we take off his gauze dressing from the needle sites (he doesn't sleep with the gauze on). I'll be honest, doing home hemo is a lot of work and takes up a lot of time, it is not always easy and I have Fibromyalgia (sort of like having arthritis) so is hard on me too but we get to watch TV together during his treatments and talk or he reads and then we do things on our days off from treatment. If we have to, we change his treatment schedule when we want, so long as he does at least 5 treatments a week. We had to sell our house because we couldn't afford it anymore and because it was too hard for us to take care of by ourselves. It's just the 2 of us so we really did not need a big house anyway. Now we live in an apartment, so no more yardwork or a big house to clean and take care and if something breaks down, the maintenance guys fix it and not us. For us, an apartment is much easier and cheaper. Sometimes I miss the house and yard and feel sad about it but overall, we are much better off in an apartment now. I am very glad that my husband does not have to mow a big yard anymore or spend what little time off he has fixing things around the house. Having a house is an investment and is wonderful but apartment life isn't so bad either. Just depends on your needs and lifestyle. Hope you and your wife find ways to make things easier on yourselves and a way for you to get better lab results. It is important that you feel well and are able to do the things you want to do. Maybe not everything you want to do but things that make you happy and feel alive. Dialysis can be a very dark life, we hate it but we find little things to enjoy and sometimes the little things turn into big happy things. Keep us posted on your progress and ask questions, there are a lot of experienced people on this site who are willing to share their experience. 

[fuzzyL]

thank you for you reply!!!!  very helpful--I can agree with the ideal of an apartment since we still live in a house and it does demand a a lot of time with the basic maint as well as occasional repairs--but like you my wife , when time allows her,will sit with me and watch tv or talk so that has been nice

[Simon Dog]

I am male--5 ft. 8 inches--about 102kg--flow fracture=35-we use 30 liters of dialysate a session-we circulate 480ml min for 97 liters cleaning a session for about 4 hours a day-4 days week-we have changed the time and flow rates more than once in the two years plus of home dialysis yet we always come just short of the clinic cleaning requirements

I am male, 6ft, 100.5 kg EDW.   I was getting a clearance of 2.0 at FF35/30L and told the RN I did not like to be at minimum.  She switched me to FF47/40L, and it raised my clearance to 2.4.   (URR went from 41% to 47%).  I'd like to get up to 50 or 60L, but I don't have the "1S" machine so I am limited to 12L/min dialysate flow.    12L doesn't get me quite to FF 47 unless I am taking off a lot of fluid (very rare for me).

Do not settle for "minimum" or "just reaching goal".

I was fortunate enough to work out a 30 hour/week schedule with my employer (and keep all full time benefits), which works nicely with a 5x/wk NxStage schedule.   I have one weekday and one weekend day off.

future home machines will be essentially at the same level as in-center machines.

This is a huge long-term risk for NxStage.

[cattlekid]

I worked full time (40 hours) and also did dialysis 5x per week 3:30 per day.  I did have very little free time and it had to be rationed carefully.  I usually dialyzed Monday and Tuesday, took Wednesday off, then dialyzed Thursday, Friday and Saturday.  Sunday was my one day that was free of work and dialysis.  I kept up with cooking and laundry, but anything else around the house got done when either DH decided it was getting bad or someone was coming to visit and I had to at least clean the basics.

thank you all for helpful advice!!!!!  brings up another question for primetimer-how does your husband have time to do that 5 times a week and work full time??  it would seem he would have very little free time or time to do projects or whatever around the house_ I do dialysis to live but doesn't seem to be much time for living between that and working-I don't ask to be a jerk, hard to pay bills on disability so I have considered returning to the work force

[Simon Dog]

I worked full time (40 hours) and also did dialysis 5x per week 3:30 per day.

So much for the "2.5 - 3 hour treatments" NxStage likes to talk about    I run about 3:35 5x/week.

[fuzzyL]

my nurse wants me to do 40 liters a session-one problem was doing 40 liters with a 60 liter sack which meant we would dump 20 liters each session which we refused to do-then my clever wife, a nurse  found the solution--day one we would do 40 leaving 20 in the bag-day 2 we hook up the portable bags-run the solution from the leftover 20 of the 40 bag, the she pauses it and we kick over to the portable bags, allowing us to do 40 a session without wasting any-we have done this a few times now  with no problems

[Simon Dog]

Depending on your lactate and K requirements, you may be able to get a smaller sak.   I'm on a 40L Rx and use a 50L sak (307) because I need 40 lactate.  If I was able to use 45 lactate, I could get the 40L sak (305).

SAKs are cheaper than bags on a per-liter basis.  It would be interesting to see the billing numbers to learn if your solution is the most cost effective.

[Vt Big Rig]

I worked full time (40 hours) and also did dialysis 5x per week 3:30 per day.

So much for the "2.5 - 3 hour treatments" NxStage likes to talk about    I run about 3:35 5x/week.

I too went into this with the impression from Next Stage ads that it would be 2.5 hours.  They forget to mention the set up time and the pulling needles and bandaging time. I am a big dude. We run a 40L batch and have just made FF 50. At FF45 my run time was 3:42 and my adequacy was over 3.1. So we were allowed to make FF50 and run time is now 3:20. Working full time but with a very understanding boss that lets me adjust my hours as needed. We run Sunday through Thursday so we can get a jump on the weekend on Friday night.

Having said that I still prefer Next Stage. My blessed wife takes better care of me than I think they would in center. So far I have not experienced any fatigue or cramping after treatments so I believe the claim about it being easier on your body.

And lets face it ..... our bodies put up with enough already. Anything to make it easier on it.