Dialyzer Filters

[PrimeTimer]

My husband says that his Fresenius center is using a dialyzer filter on him now that is much much bigger than the one we used with his NxStage cycler. Well, I think all the filters at centers are bigger but he said this particular one is even bigger than some of the others. He has the same neph that he had when he was doing home-hemo and she wrote the order for the bigger one. Sorry to be so vague with this, I wasn't there but he said his neph told him she wanted the bigger filter used on him because of his large size. I want him to write down the type so I can update here. Meanwhile, his Hemoglobin has dropped from an 11 to a 10. Other than that and feeling tired, he's doing okay.

[Simon Dog]

The hi flux filters used in clinics are sized 160, 280, 200 and 250.   Getting a 180 instead of a 160 is easy; getting 200 or larger requires approval from the PMT (cost control) committee due to increased cost.  All are physically larger than the NxStage filter. 160 is the default.  I'm 109kg EDW and use a 180 when I go in-center for travel or other reasons.

NxStage makes a cartridge that uses these filters, but it's generally used only on patients with a negative reaction to the NxStage filter since the priming process is a pain in the butt.

[SutureSelf]

My husband says that his Fresenius center is using a dialyzer filter on him now that is much much bigger than the one we used with his NxStage cycler. Well, I think all the filters at centers are bigger but he said this particular one is even bigger than some of the others. He has the same neph that he had when he was doing home-hemo and she wrote the order for the bigger one. Sorry to be so vague with this, I wasn't there but he said his neph told him she wanted the bigger filter used on him because of his large size. I want him to write down the type so I can update here. Meanwhile, his Hemoglobin has dropped from an 11 to a 10. Other than that and feeling tired, he's doing okay.

These are the standard dialyzers used by Fresenius in their US centers:

Fresenius Optiflux160 NR
Fresenius Optiflux180 NR
Fresenius Optiflux200 NR
Fresenius Optiflux250 NR

** NR = No Reuse/Single Use Only filter

At most centers it seems the Fresenius Optiflux 180 NR is the default filter.  However, does your husband's clinic practice dialyzer reuse?  And, if so, are they using a multi-use dialyzer on him?  Those dialyzers are larger than the Optiflux NR series.  Also, in some dialysis centers, if a patient refuses to sign off on allowing multi-use filters (patient has to sign an informed consent form), they will only provide a low flux dialyzer.  Those are larger, but do not provide clearances equal to the comparable Optiflux dialyzer.

I'm small frame, but use an Optiflux 200 NR.  The nephs at my not for profit clinic (but run by a for profit dialysis management company) have more leeway in setting the dialysis prescription than those at a for profit center.



 

[Simon Dog]

At most centers it seems the Fresenius Optiflux 180 NR is the default filter.  However, does your husband's clinic practice dialyzer reuse?  And, if so, are they using a multi-use dialyzer on him?  Those dialyzers are larger than the Optiflux NR series.  Also, in some dialysis centers, if a patient refuses to sign off on allowing multi-use filters (patient has to sign an informed consent form), they will only provide a low flux dialyzer.  Those are larger, but do not provide clearances equal to the comparable Optiflux dialyzer.

I'm small frame, but use an Optiflux 200 NR.  The nephs at my not for profit clinic (but run by a for profit dialysis management company) have more leeway in setting the dialysis prescription than those at a for profit center.

The standard at the clinic I used is the 160NR.   I have a great neph, but I still had to ask to get the 180.   It's annoying because a 180NR gives me clearly "good enough" dialysis, but I suspect I would get a little better clearance with the 200NR.

Loads of info at http://fmcna-dialyzers.com/.   The "Optiflux" series is the one I have commonly encountered at clinics.

Federal prisoners are generally issued the 250 (seriously). 

Forcing a low flux dialyzer on someone refusing re-use would appear to be a method to punish the patient for not playing ball while still maintaining the illusion you have choice.  "Sure, you can have sub-optimal treatment if you don't want re-use".   Curiously, the big for-profit centers seem to be heading away from reuse.

The home care nurse does not seem to be constrained to minimizing the use of supplies when issuing the home Rx.  I was getting adequate clearance with a 30L NxStage Rx, however, I told here I wanted to be well over the line.  The result was that instead of getting two treatments from a 60L sak, I now get one 40L treatment from a 50L sak, thow out 10L, and use twice as many saks.   

[PrimeTimer]

Thanks, guys! Husband says they definitely use a NR (non-reuse) on him because they unwrap a fresh one each time and according to the pics from Simon's link, he thinks it's the 180NR. Told him to find out for sure at his next treatment. He reads your posts and I told him you guys know stuff about filters. That seemed to get his interest up, so thanks. He's been controlling his fluid very well, they love him for that. He usually only has well-under 2 liters to remove. He sweats a lot as he runs around outdoors every day. He limits his intake and is also an ice-cube guy. Why his hemoglobin has dropped concerns us. There's been no inadvertent/accidental blood loss. They are giving him more EPO (3xweek) and Iron. He's usually not been tired unless his hemoglobin is below 11...and since it is, he was not surprised by his labs but puzzled as to why it dropped. 

[Simon Dog]

My MD targets a 10-11 HGB range.   The risk of thrombolytics side effects of ESAs like EPO increases when using it to try to get HGB to a "normal" range.

I have had good luck with monthly (and occasionaly bi-monthly) Micera.

[SutureSelf]

My MD targets a 10-11 HGB range.   The risk of thrombolytics side effects of ESAs like EPO increases when using it to try to get HGB to a "normal" range.

I have had good luck with monthly (and occasionaly bi-monthly) Micera.

Until about a year ago my neph and the others in her group also set hgb target by the EPO black box warning to between 10-11 as well.  However, since then she changed it to between 11.5-12.  The reason?  Of all the latest studies done in the mid 2000s on ESA's,  NONE were specific to dialysis patients.  The FDA's black box warnings were based off 4 studies done on patients with cancer and 2 studies for predialysis patients. For my neph's patients who didn't fall into those categories, she never had any problems in the past, and decided no reason to expect so in the future.  Basically, with the bundled rate going into effect at the same time as the black box warning, it gave dialysis centers, especially for profits, a "viable" reason to cut back on ESA adminstration, even though nothing was proven harmful for dialysis patients.

From Home Dialysis Central -

FDA Black Box Warnings
The FDA issues a black box warning when research suggests that a drug may cause harm in some cases. A black box warning was placed on all ESAs in March, 2007, due to new research. None of the new studies were of people on dialysis.

In people with cancer, four new studies found problems when EPO was used:

A number of studies have linked anemia with poor outcomes in people with head and neck cancers. 5,6,7,8 But in a Danish study, patients given EPO to reach a (normal) Hb target of 14 to 15.5 g/dL did worse than those who took a placebo.
A study of cancer patients not on chemo found that EPO did not reduce the need for transfusions (the target Hb was 12 g/dL). Patients who took EPO were also more likely to die. 9
A study of whether EPO would improve quality of life in people with non-small cell lung cancer was stopped early. More people in the EPO group died than those who took a placebo. Target Hb was 12 to 14 g/dL.
Hoffman-La Roche was testing a new ESA in people with non-small cell lung cancer (Hb target of 11 to 13 g/dL). Those who took the drug were more likely to die. The study was stopped early.
The FDA also looked at two studies in chronic kidney disease (CKD) before dialysis:

The CHOIR study found that patients in a higher Hb group (target of 13.5 g/dL) had more heart problems, hospital stays, or death than those in a lower Hb group (target of 11.3 g/dL). 10
The CREATE study failed to show that full correction of anemia in CKD (target of 13 to 15 g/dL) would prevent heart damage. This study used epoetin beta, a drug that is not sold in the U.S. 11

http://homedialysis.org/life-at-home/articles/anemia-epo-kidney-failure-and-you


To be fair and balanced, this from Hemodoc on his blog.  However, take into consideration he is also a cancer survivor as well as ESRD patient -

http://www.hemodoc.info/2011/12/epo-lighting-the-fires-of-cancer.html

[kickingandscreaming]

Thank you, SutureSelf.

I think the whole EPO question is most central to a decent quality of life.  My Hg has been low lately and I am just limping along with no stamina.  Everything feels hard-- except going back to bed. 

My PD nurse was out with double car accidents and my EPO shot (which I have to go into the clinic to get) was delayed and my Hg slipped to 8.4.  I was useless.  Then I got my "fix" and felt much better except that I had to climb out of a deep hole.  If I hit 11, alarms go off and I feel like a real human for a while (God forbid!).  I don't think my neph is open to skirting the "black box" warnings even if they have nothing to do with us.  But I will share the article with her.

[PrimeTimer]

Got confirmation: They use a Fresenius Optiflux 180 NR filter on my husband. Neph visited him today. Hemoglobin went down to a 9+. Neph thinks it had something to do with a low Ferritin level. He takes Vitamin D3 but she's added D2 to his regime now to boost his Ferritin and Iron levels. Hhmm...I hadn't thought of that. I had wondered if the bigger filter had anything to do with it but nope, he has an iron deficiency. My guess is that he needs to eat more and he needs to eat better (and I need to sharpen my culinary skills  ). Meanwhile, take the supplements ordered by the doc. 

[SutureSelf]

Got confirmation: They use a Fresenius Optiflux 180 NR filter on my husband. Neph visited him today. Hemoglobin went down to a 9+. Neph thinks it had something to do with a low Ferritin level. He takes Vitamin D3 but she's added D2 to his regime now to boost his Ferritin and Iron levels. Hhmm...I hadn't thought of that. I had wondered if the bigger filter had anything to do with it but nope, he has an iron deficiency. My guess is that he needs to eat more and he needs to eat better (and I need to sharpen my culinary skills  ). Meanwhile, take the supplements ordered by the doc.

Is he receiving IV Iron at the clinic, like Venofer or Ferrlecit?  Remember from one of your past threads, EPO won't help to raise hgb unless iron stores are sufficient.  I take 3 - 100 mg doses of Venofer (over consecutive dialysis treatments) if my Iron Sat goes below 25% and/or Ferriten drops below 200.

This is a good discussion on IV iron supplementation from Home Dialysis Central -

http://forums.homedialysis.org/threads/1172-Epo-Iron-question


IHD discussion on IV iron from Zach

http://ihatedialysis.com/forum/index.php?topic=19535.msg331138#msg331138

http://ihatedialysis.com/forum/index.php?topic=19535.msg331138#msg331138


An Optiflux 200NR would be better, but the 180 is a good start.  How long are his treatments?  Although not equal to total run time while on NxStage, I hope his prescription is for at least 4.5 hours per treatment.

[PrimeTimer]

Got confirmation: They use a Fresenius Optiflux 180 NR filter on my husband. Neph visited him today. Hemoglobin went down to a 9+. Neph thinks it had something to do with a low Ferritin level. He takes Vitamin D3 but she's added D2 to his regime now to boost his Ferritin and Iron levels. Hhmm...I hadn't thought of that. I had wondered if the bigger filter had anything to do with it but nope, he has an iron deficiency. My guess is that he needs to eat more and he needs to eat better (and I need to sharpen my culinary skills  ). Meanwhile, take the supplements ordered by the doc.

Is he receiving IV Iron at the clinic, like Venofer or Ferrlecit?  Remember from one of your past threads, EPO won't help to raise hgb unless iron stores are sufficient.  I take 3 - 100 mg doses of Venofer (over consecutive dialysis treatments) if my Iron Sat goes below 25% and/or Ferriten drops below 200.

This is a good discussion on IV iron supplementation from Home Dialysis Central -

http://forums.homedialysis.org/threads/1172-Epo-Iron-question


IHD discussion on IV iron from Zach

http://ihatedialysis.com/forum/index.php?topic=19535.msg331138#msg331138

http://ihatedialysis.com/forum/index.php?topic=19535.msg331138#msg331138


An Optiflux 200NR would be better, but the 180 is a good start.  How long are his treatments?  Although not equal to total run time while on NxStage, I hope his prescription is for at least 4.5 hours per treatment.

Thanks, SutureSelf! I actually printed out the links for him to read -TONITE. BTW, he does 4 hours 3xweek at the center.