High Blood Pressure and High Venous Pressures

[Len]

 Yes  I understand  what your saying now   ok I have another question at the clinic I ran 400 pump speed  now that was
  96 litres of blood cleaned per run   96 x3=288 per week, then at home I started 6 hr runs  200 pump speed
                                                   72x6 =432 per week  now I run 8 hrs  6 days
                                                   96x6=576 per week
 at the clinic my % ran about 69%    then when I was on 6 hr runs at home   getteing more  litres cleaned   my % dropped to 59% ??  I will be doing bloodwork tonight   to see if  doing 8 hours a night has increased  my %  but cant see why it dropped  going from the clinic  to Home hemo ?

[hyperlite]

Len what do you mean by %?

[Len]

Hyperlite  have you joined the chatroom yet  ?if so  try it for a min

[Gus]

That is just how it works over here. Pressures of 200 is too high, and 450 pump speed is crazy. You see in your country the idea of dialysis is hard and fast, which isn't good for your heart. The US have a higher death rate than us, so you do the math.

Nope, it doesn't apply to Daily-Short dialysis which am doing at the moment..........the high mortality rate has to do with other underlying factors.....inadequate dialysis, in turn causing high blood pressure..the number one cause of deaths......so 3x a week with free days in between doesn't do the cut..........daily-short and Nocturnal everyday do the cut.......

The whole idea is to keep fluid and toxins at bay........

[Panda_9]

It is my understanding that the higher the pump speed, the more strain on the heart. Im not 100% on this, Im just going on what Ive been told during my training. I will try find out. When you think about it, the machine is pulling blood from you pretty close to your heart. Surely there would have to be some impact when you are pulling it out at high speeds.

[Gus]

It is my understanding that the higher the pump speed, the more strain on the heart. Im not 100% on this, Im just going on what Ive been told during my training. I will try find out. When you think about it, the machine is pulling blood from you pretty close to your heart. Surely there would have to be some impact when you are pulling it out at high speeds.

The biggest strain is having too much fluid to take off......that hurts, but for people dialyzing short periods  everyday for 2.5 - 2.7 hours and only needing .3 - 1.2lg of fluid taken out and running a blood pump speed of 400-450 will not harm the heart. If you ask why its because the heart is not beeing stretched like a balloon like those people who dialyze 3x a week and coming in with over 2kg of fluid overload.

Its one of the reasons of high mortality rates in the USA..... 3x a week dialysis is not enough.......the whole body is getting damaged very slowly..............I am living proof of that.....I been dialyzing since 1978 and in 2004 went home to dialyze everyday with all my previous years in-center.....today, my hand nerves are damaged, severe carpal tunnel, stiff joints, I don't feel as good as I use to.......if I have started daily-short or Nocturnal dialysis sooner I would have saved time........but am glad I made the switch....my blood pressure is normal now.

But once again, high blood pump speed is hard on people doing 3x a week as they come in with fluid gains over 2kg, and less problemetic with those who do daily-short and nocturnal........

[Panda_9]

I'm not talking about fluid gains, I know what that does to you. I'm talking about the pump speed.

[Len]

As I see it Amber  if you take blood out @400 ml per min  its going back into you @ 400 ml a min a few inches away ,therefore  it wouldnt have any effect on your heart

[hyperlite]

Blood Flow Rate (BFR)
There is a misconception concerning BFR and heart overload. (BFR = Blood Flow Rate)
The heart is overloaded constantly by the extra blood it has to circulate through the shunt (fistula).
Pumping the blood during dialysis doesn't add to the overload.
For example, if you have 1000 cc/min flow in the shunt and your BFR is 400 cc/min, the blood pump doesn't change the total shunt flow, it just takes 400 cc/min from the arterial needle and returns it through the venous needle. In the area between the two needles the blood flow is 600 cc/min.
Of course the BFR cannot be higher than the flow through the shunt. As a rule of thumb, it shouldn't be higher than 50% of the shunt flow.

The rate of waste removal increases as the blood flow increases until BFR is about one half of the DFR (Dialysate Flow Rate). Increasing BFR beyond that doesn't help much. Reducing BFR requires more time for adequate dialysis.
BFR setting is directly linked to the arterial and venous pressure as explained next.

I got that from http://www.pipeline.com/~gil1/esrd/dmachine.htm

[kitkatz]

Hyperlite is a:
      Science Geek!

Katherine

[Panda_9]

Seems I have caused a bit of debate. Im just waiting to get an answer to my question elsewhere and Ill post as soon as I do. 

[hyperlite]

Hyperlite is a:
      Science Geek!

Katherine

haha took you this long to figure that out???

[Gus]

Not really,

Now explain the low dialysate flow rates on a NxStage.......

[hyperlite]

Not really,

Now explain the low dialysate flow rates on a NxStage.......

I don't know much about the NxStage system, but from what I do know about dialysate flows, the lower the flow, the longer you go. So basically if you're using a flow of 100, you'll need to do more dialysis to get the same KT/V or dialysis efficacy compared to a 500 flow. The upside is a gentler dialysis. So someone doing daily hemodialysis would be able to use a lower dialysate flow. Someone only doing 3x4hrs would have to use the higher dialysate flow.

[Gus]

Not really,

Now explain the low dialysate flow rates on a NxStage.......

I don't know much about the NxStage system, but from what I do know about dialysate flows, the lower the flow, the longer you go. So basically if you're using a flow of 100, you'll need to do more dialysis to get the same KT/V or dialysis efficacy compared to a 500 flow. The upside is a gentler dialysis. So someone doing daily hemodialysis would be able to use a lower dialysate flow. Someone only doing 3x4hrs would have to use the higher dialysate flow.

Did you know you don't really need dialysate to have dialysis? All it does is balance electrolytes........that way you don't pass out.......back in the early years of dialysis research patients would drink 5 liters of dialysate orally......

[Panda_9]

"All it does is balance electrolytes"

What do you mean ALL it does??? I dont understand what you mean, are you saying we dont need to balance our electrolytes?
I cant see what good it would do drinking the dialysate. I would think it would only raise your K too high and what not.

[Rerun]

Why don't they take 2 cups of blood out and spin the hell out of it and wash, wash, wash, it and put it back in and take the next amount and spin the hell out of it and so on for an hour and we'd be done! 

DO I HAVE TO THINK OF EVERYTHING??? 

[hyperlite]

Did you know you don't really need dialysate to have dialysis? All it does is balance electrolytes........that way you don't pass out.......back in the early years of dialysis research patients would drink 5 liters of dialysate orally......

Uh, yes you do...The dialysate is basically what "cleans" your blood. The dialysate runs in a "counter-current" flow (so opposite of your blood). It is kept at approximately body temperature and consists of a sterilized solution of mineral ions. Urea and other uremic toxins, as well as potassium and phosphate, diffuse into the dialysis solution. However, concentrations of most mineral ions (eg sodium) are similar to those of normal plasma to prevent loss. So only the stuff you don't need, leaves.

You don't need dialysate to remove fluid though. Fluid removal is achieved by altering the hydrostatic pressure of the blood compartment, causing free water to move across the membrane along a pressure gradient...

Back in the early days, patients might have had to drink dialysate containing electrolytes that would be sucked out. Because they probably didn't have the techniques to mix up a dialysate in the machine that was able to take out the Urea, potassium and phosphate...But i dunno, I don't know how dialysis used to work.

[Gus]

Of course we need it but in theory its a balance between the outer part and inner part of the dialyzer......but still having UFR on without dialysate releases the larger particles from your blood including fluid. However, you don't want to do that or else you pass out after a few seconds.......

The whole point is that dialysate has nothing to do with how high you set the blood pump speed. If the fistula transonic tests show excellent flow then you can have the blood pump speeds as high as you can tolerate.......

For example, the highest I can tolerate is 430 .....anything higher than that would make me dizzy...........it all depends on you fistula and how high you can go.

On the other hand dialyzing 6-8 hours per night with low pump speeds is the best way to go........molecules like that of Amyloidosis are taken out better......

[hyperlite]

Of course we need it but in theory its a balance between the outer part and inner part of the dialyzer......but still having UFR on without dialysate releases the larger particles from your blood including fluid. However, you don't want to do that or else you pass out after a few seconds.......

The whole point is that dialysate has nothing to do with how high you set the blood pump speed. If the fistula transonic tests show excellent flow then you can have the blood pump speeds as high as you can tolerate.......

For example, the highest I can tolerate is 430 .....anything higher than that would make me dizzy...........it all depends on you fistula and how high you can go.

On the other hand dialyzing 6-8 hours per night with low pump speeds is the best way to go........molecules like that of Amyloidosis are taken out better......

Who said that dialysate has anything to do with how high you set the pump speed?

[Gus]

hyperlite@ I was trained for this stuff........

There are many people confused about dialysate flow speeds, but we know that in-center dialysis machines can be adjusted as high as you want, for that reason is that they need to speed up treatment asap for the patient.....in a very short time at 3x a week.....if its not fast enough then the balance between electrolytes and the blood won't match........that's why they use High Flux dialyzers....that kind of dialysis is not healthy for the patient at 3x a week.......its all about economics....dialyzing alot more patients in one single day.......so they need it fast fast fast.....

Butreal kidneys don't work like that.......Nocturnal nightly dialysis is the answer, then daily-short comes next......

[hyperlite]

haha Gus I like how somewhere in your posts, you always put it a little "plug" for homedialysis, and a "knock" against normal 3x a week. 
But yeah I agree with you, the higher dialysate flow basically uses more dialysate, and therefore cleans your blood faster. But I don't know what you are talking about when you say if the dialysate isn't fast enough, then the balance between the electrolytes and the blood won't match.
-From what I understand, its just a fancy form of osmosis. So theres two fluids (blood / dialysate) and a membrane in the middle. The dialysate is packed full of stuff you want to keep in your blood (so the gradient is in equilibrium) and therefore that stuff doesn't cross the membrane. But the dialysate doesn't have any of the stuff you are trying to take out, like Urea, Potassium, Phosphates...etc. So therefore those things travel down their concentration gradient, from your blood, through the membrane (by osmosis) and into the dialysate. So if the dialysate is flowing slowly, then it will take longer to clean out all of the blood, because as the "dirty blood" gets to the dialysate, if the "dirty dialysate" hasn't moved on to make room for the fresh dialysate, than the blood will continue on without getting cleaned, until it makes the cycle again. Therefore, faster dialysate, faster clean. The concentration of the stuff you want to keep isn't changing, so it wouldn't matter if the dialysate was flowing fast or slow, as long as it was in contact with the blood (but separated by a selectively permeable membrane).

does that make sense?

[Gus]

haha Gus I like how somewhere in your posts, you always put it a little "plug" for homedialysis, and a "knock" against normal 3x a week. 

Its a fact, 3x a week is not sufficient....people die sooner......I don't want to scare the heck out of you all but your life will not improve doing it 3x a week for over 3 years! Your health will just go downhill.....slowly.......


But yeah I agree with you, the higher dialysate flow basically uses more dialysate, and therefore cleans your blood faster. But I don't know what you are talking about when you say if the dialysate isn't fast enough, then the balance between the electrolytes and the blood won't match.


Keep in mind that the dialysate in-center is not ULTRA-PURE..that's why its fast fast fast, it needs to pass many times......while dialysate for home such as NxStage and Aksys uses Ultra-Pure....which only needs to pass once........some Fresenius machines have Ultra-Pure features.......

-From what I understand, its just a fancy form of osmosis. So theres two fluids (blood / dialysate) and a membrane in the middle. The dialysate is packed full of stuff you want to keep in your blood (so the gradient is in equilibrium) and therefore that stuff doesn't cross the membrane. But the dialysate doesn't have any of the stuff you are trying to take out, like Urea, Potassium, Phosphates...etc. So therefore those things travel down their concentration gradient, from your blood, through the membrane (by osmosis) and into the dialysate. So if the dialysate is flowing slowly, then it will take longer to clean out all of the blood, because as the "dirty blood" gets to the dialysate, if the "dirty dialysate" hasn't moved on to make room for the fresh dialysate, than the blood will continue on without getting cleaned, until it makes the cycle again. Therefore, faster dialysate, faster clean. The concentration of the stuff you want to keep isn't changing, so it wouldn't matter if the dialysate was flowing fast or slow, as long as it was in contact with the blood (but separated by a selectively permeable membrane).


Standard dialysate is acceptable but not the best.....that's why some of us sometimes feel chills, reactions, or even get blood infections..........

does that make sense?


No, hehehe...joking........seriously, Nocturnal, or Dialy-short will prolong your life......its not really the blood pump speed but the whole therapy as in whole.......more frequent dialysis will let you live longer....

[Epoman]

haha Gus I like how somewhere in your posts, you always put it a little "plug" for homedialysis, and a "knock" against normal 3x a week. 
But yeah I agree with you, the higher dialysate flow basically uses more dialysate, and therefore cleans your blood faster. But I don't know what you are talking about when you say if the dialysate isn't fast enough, then the balance between the electrolytes and the blood won't match.
-From what I understand, its just a fancy form of osmosis. So theres two fluids (blood / dialysate) and a membrane in the middle. The dialysate is packed full of stuff you want to keep in your blood (so the gradient is in equilibrium) and therefore that stuff doesn't cross the membrane. But the dialysate doesn't have any of the stuff you are trying to take out, like Urea, Potassium, Phosphates...etc. So therefore those things travel down their concentration gradient, from your blood, through the membrane (by osmosis) and into the dialysate. So if the dialysate is flowing slowly, then it will take longer to clean out all of the blood, because as the "dirty blood" gets to the dialysate, if the "dirty dialysate" hasn't moved on to make room for the fresh dialysate, than the blood will continue on without getting cleaned, until it makes the cycle again. Therefore, faster dialysate, faster clean. The concentration of the stuff you want to keep isn't changing, so it wouldn't matter if the dialysate was flowing fast or slow, as long as it was in contact with the blood (but separated by a selectively permeable membrane).

does that make sense?

Well I'm glad someone else mentioned it here on the board instead of PM'ing me (again). It really does get old after awhile and to be honest it always makes me feel like shit. We get it, daily is better than 3X but there are ALOT of people on 3X in-center and they have NO choice. No doubt NxStage is a remarkable machine but when I start it, I won't be constantly reminding people much better I am doing than in-center people doing dialysis 5-6 times a week. I actually have had members PM me and tell me that you come off like an elitist. But honestly Gus, some people myself included get upset when you plug dialy-hemo constantly, we get it already we are all not as lucky as the elite people at the homedialysis site. It makes me feel like I have been cheated all these years and I am doomed. I hope you understand what I am saying and do not get offended. But I personally am getting tired of hearing how much faster 3x'ers are going to die. It's actually insensitive of you. Yeah this is a place to get the truth but lets have some tact. Try to remember that a VERY, VERY small percentage of people can do home/daily due to MANY, MANY factors.

- Epoman

[Gus]

haha Gus I like how somewhere in your posts, you always put it a little "plug" for homedialysis, and a "knock" against normal 3x a week. 
But yeah I agree with you, the higher dialysate flow basically uses more dialysate, and therefore cleans your blood faster. But I don't know what you are talking about when you say if the dialysate isn't fast enough, then the balance between the electrolytes and the blood won't match.
-From what I understand, its just a fancy form of osmosis. So theres two fluids (blood / dialysate) and a membrane in the middle. The dialysate is packed full of stuff you want to keep in your blood (so the gradient is in equilibrium) and therefore that stuff doesn't cross the membrane. But the dialysate doesn't have any of the stuff you are trying to take out, like Urea, Potassium, Phosphates...etc. So therefore those things travel down their concentration gradient, from your blood, through the membrane (by osmosis) and into the dialysate. So if the dialysate is flowing slowly, then it will take longer to clean out all of the blood, because as the "dirty blood" gets to the dialysate, if the "dirty dialysate" hasn't moved on to make room for the fresh dialysate, than the blood will continue on without getting cleaned, until it makes the cycle again. Therefore, faster dialysate, faster clean. The concentration of the stuff you want to keep isn't changing, so it wouldn't matter if the dialysate was flowing fast or slow, as long as it was in contact with the blood (but separated by a selectively permeable membrane).

does that make sense?

Well I'm glad someone else mentioned it here on the board instead of PM'ing me (again). It really does get old after awhile and to be honest it always makes me feel like shit. We get it, daily is better than 3X but there are ALOT of people on 3X in-center and they have NO choice. No doubt NxStage is a remarkable machine but when I start it, I won't be constantly reminding people much better I am doing than in-center people doing dialysis 5-6 times a week. I actually have had members PM me and tell me that you come off like an elitist. But honestly Gus, some people myself included get upset when you plug dialy-hemo constantly, we get it already we are all not as lucky as the elite people at the homedialysis site. It makes me feel like I have been cheated all these years and I am doomed. I hope you understand what I am saying and do not get offended. But I personally am getting tired of hearing how much faster 3x'ers are going to die. It's actually insensitive of you. Yeah this is a place to get the truth but lets have some tact. Try to remember that a VERY, VERY small percentage of people can do home/daily due to MANY, MANY factors.

- Epoman

This thread is about "Home Dialysis" right? So we stick to the subject and the facts........right now, we the community are pushing hard to pass legislation so that in-center patients on a wide basis can have that option, but clearly clearly I say that what I am speaking here is what patients wanting to go home and who can go home get the information straight-hand.

Do you really care about people's lives? Did you already email your congressman to get these bills passed? it a very important issue here and all over the net people want to know the answers about living a long life on dialysis.

Some of you may be unfortunate, you can make choices. You can fight for a better life. Can you? If you really care please visit this page and email your congressman today...... its about peoples lives.....

http://capwiz.com/meiresearch/home/