Dr. downsized my dialyzer AFTER 2.5 YEARS

[z28rod]

Iam 49yrs old and have been on dialysis for 2.5yrs. Just today my dr. tells me he is changing my dialyzer from a frecinius 200 to a 180. IAM A LARGE MAN 6'4" 357LBS and not all fat . My urr is 67 now and spkt/v is 1.42. He is telling me that the smaller dialyzer will "work fine".And aganst my wishes he changed the chart. How can that be ? Please help !And can Frecenius tell him to do this to save money ?

[goofynina]

I wish i had the answer you need to hear Brent but i do know that you are the patient and you are entitled to answers.  See how your labs are after your run and if it doesnt work for you demand them to put you back on the 200.   I am a large woman as well and i know they had to do alot of adjusting to get me to where i needed to be (which never worked cuz i wasnt compliant with my fluid or my diet intake)    I am on PD now and it has worked better for me than Hemo ever did.  I hope everything works out for you, please keep us posted as i am sure this problem isnt uncommon and there will be others in the same predicament that need answers as well.  Have a good one my friend 

[stauffenberg]

Ordinary dialysis replaces only 10 to 12% of normal renal function, so all patients always need much more dialysis than they ever get.  The normal dialysis dose of 4 hours, three times a week was not based on what the body needs for its blood chemistry to normalize, but rather, on an epidemiological, cost-benefit assessment of the critical point at which the cost of extra dialysis was not worth it to the healthcare system in terms of the reduction in the cost of hospitalization due to inadequate dialysis that would be realized by increasing the dialysis dose.

At my dialysis center, the clinical goal set was that the patient should have a kt/v of 2.0 -- though of course, even if this had been attained, as it only rarely was, that would not have been equivalent to normal renal function.

[BigSky]

It used to be that a minimum Kt/V of 1.2 was recommended.  The latest stuff I read on Kt/V is that is should be minimum of 1.4 for hemo patients and 1.7 if those hemo patients are diabetic.

I would inform the doctor if your Kt/V drops below that you will be suing him for malpractice considering he is changing filters over your protests.

[z28rod]

Also I want to ad that Iam on the machine for 4.5 hrs. I think Fercineous is trying to tell my dr. to save money. My dr. is the medical director at my unit. This boggles my mind being from an engineering background.

[z28rod]

bmp

[goofynina]

So z28rod? How have you been feeling?  are they still using the 180?  Have you noticed a difference?   I hope they are not giving you a hard time about switching you back if it isnt working out for you, Please keep us updated. 

[z28rod]

I have noticed a slight decrease in energy level, just enough to be annoying. I want to wait until my labs are done and if my levels go down then I will have a meeting and tell them I want the 200 back.

[z28rod]

I got my labs back today and my urr went from 65 to 62 and creatinine bun etc. all were worse. So now I am going to have a meeting with my Dr. on thur. and tell him I want my 200 dialyzer back. Will keep this updated.

[goofynina]

Good for you z28rod, I am glad to see you are on top of your labs and you are doing something about it,  Good Luck and yes please, do keep us updated as to what they plan on doing for you.   

[z28rod]

Well I told the manager of the unit either give me back my 200 dialyzer or iam going to davita, ha next day dr. gives me back my 200. I say hit them in the pocket book, works every time.

[paddbear0000]

  Way to go!

[goofynina]

Good for you z28rod, i am glad you spoke up and i am even more glad that they listened to you 

[Joe Paul]

Good you got your 200 size dialyzer back, too bad you had to threaten them to get what you wanted.