I Hate Dialysis Message Board
Dialysis Discussion => Dialysis: General Discussion => Topic started by: obsidianom on March 15, 2014, 06:26:14 AM
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The following is a brief synopsis from Home Dialyzers Network, courtesy of Dr. Agar who is in Austrlia and one of the worlds leading experts on Dialysis . He has communicated this to me numerous times and now he presents this to everyone. SLOW DOWN THE BLOOD SPEED, SAVE YOUR FISTULA and ORGANS!
Don’t Flog The Fistulas: Slow Hemodialysis Blood Flow!
Posted March 14th, 2014
The use of excessively high blood flow rates (read "pump speed") during dialysis-flow rates of upwards of 350 ml/minute-appears to be a US-only phenomenon (read "tragedy"). Read the post
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I am not computer savy enough to know how to get the entire article for you all to read. Perhaps someone else can do it.
Dr. Agar beleives any blood speed over 350 is dangerous and the proof is simply how much worse the outcomes are in the US compared to countries like Japan and Australia where they run well under 350. ( I personally run ours at 340 on Nxstage).
I found some new research the other day on this and couldnt seem to copy it. Dr. Agar also noted it in his article. Basically the venous flow in the fistula is effected a huge amount by blood speed . As the speed increases it creates damage. The following is from DR. Agar about this.:
"On a different but parallel plane, the December 2013 issue of CJASN featured a special section on fistula flow and flow dynamics. It emphasised the many causes of turbulence that accompany venous limb endothelial damage and in-fistula stenosis. One of these is the interruption and/or disruption of normal vascular laminar flow that occurs when the venous needle return jets into and against the venous endothelium at the site of venous return, creating physical turbulence and biochemical excitation of nitric oxide production...factors intimately associated with up-stream in-vessel stenosis."
Dr. Agar has informed me in his country they see far less fistula stenosis and constant needs to "repair" and replace fistulas then here in the US where we run ridiculously fast blood speeds of 400 or more. It makes so much sense logically to see that slamming high speed blood into a blood vessel is so beyond what the vessell was intended by nature to do that of course we see the damage we get in the US. This doesnt have to happen if we slow down the flow. We are also damaging and stunning the heart doing this.
SIMPLY PUT WE ARE KILLING PEOPLE.
I realize a lot of this is due to our nephrologists and the insurance coverage they deal with giving short 3 times per week dialysis here in the US. So we speed up the blood flow to make up for lack of time . As Dr. Agar writes in his article, this is a very poor and dangerous way to do dialysis. The answer is slower blood flow and MORE TIME ON MACHINE.
For those who can , try to get more time on machine in- center and ask to slow down the blood speed. For those at home ,DO IT YOURSELVES . Nxstage for example will do fine at 340 blood speed as it is VOLUME driven rather than speed of blood. (My wife for example gets a KT/V(FOR WHAT ITS WORTH) of 3.24 running at 340 blood speed. Her urea reduction even on Nxstage is near 65%.) IT CAN BE DONE. For those on the other machine , work with your team to come up with a formula that allows enough time on machine to allow you to slow down the blood speed and still get adaquate dialysis.
Remember , KT/V while flawed still comes down to either speeding up blood which increases K or adding TIME which increases T . Dr. Agar writes this simply and his point is in the US we go for K which causes morbidity and mortality while in other countries they raise T which saves fistulas and lives.
So which is it? Are you going to be a K or a T?? K KILLS while T Trumps all.
Just a note on Time. Dr. Agar writes that the minimum time on machine should be over 10% of total weekly time or about 17 hours per week.
If I can help anyone here to get your team to do this with you, please ask. This may be the biggest thing you can do for your health on dialysis.
BE well.
-
The following is a brief synopsis from Home Dialyzers Network, courtesy of Dr. Agar who is in Austrlia and one of the worlds leading experts on Dialysis . He has communicated this to me numerous times and now he presents this to everyone. SLOW DOWN THE BLOOD SPEED, SAVE YOUR FISTULA and ORGANS!
Don’t Flog The Fistulas: Slow Hemodialysis Blood Flow!
Posted March 14th, 2014
Hi obsidianom in my clinic not a chance doing longer they would make us do it another day to make up extra time , pity we cant strap down the experts to a chair with 2 needles in the arm sucking the life out of you to sit in a chair and see how they would feel about telling people to spend more time on dialysis its enough we have to do it in the first place to live - egg heads they have no idea but thanks for posting this letter anyway obsidianom, happy paddys weekend
The use of excessively high blood flow rates (read "pump speed") during dialysis-flow rates of upwards of 350 ml/minute-appears to be a US-only phenomenon (read "tragedy"). Read the post
This newsletter is made possible through
Medical Education Institute | Kidney School™ | Life Options | KDQOL COMPLETE™
Copyright © 2013 Medical Education Institute, Inc., a 501(c)(3) organization. All Rights Reserved.
414 D'Onofrio Drive, Suite 200 | Madison, WI 53719 608-833-8033
you are receiving these emails as part of the Home Dialysis Central mailing list.
I am not computer savy enough to know how to get the entire article for you all to read. Perhaps someone else can do it.
Dr. Agar beleives any blood speed over 350 is dangerous and the proof is simply how much worse the outcomes are in the US compared to countries like Japan and Australia where they run well under 350. ( I personally run ours at 340 on Nxstage).
I found some new research the other day on this and couldnt seem to copy it. Dr. Agar also noted it in his article. Basically the venous flow in the fistula is effected a huge amount by blood speed . As the speed increases it creates damage. The following is from DR. Agar about this.:
"On a different but parallel plane, the December 2013 issue of CJASN featured a special section on fistula flow and flow dynamics. It emphasised the many causes of turbulence that accompany venous limb endothelial damage and in-fistula stenosis. One of these is the interruption and/or disruption of normal vascular laminar flow that occurs when the venous needle return jets into and against the venous endothelium at the site of venous return, creating physical turbulence and biochemical excitation of nitric oxide production...factors intimately associated with up-stream in-vessel stenosis."
Dr. Agar has informed me in his country they see far less fistula stenosis and constant needs to "repair" and replace fistulas then here in the US where we run ridiculously fast blood speeds of 400 or more. It makes so much sense logically to see that slamming high speed blood into a blood vessel is so beyond what the vessell was intended by nature to do that of course we see the damage we get in the US. This doesnt have to happen if we slow down the flow. We are also damaging and stunning the heart doing this.
SIMPLY PUT WE ARE KILLING PEOPLE.
I realize a lot of this is due to our nephrologists and the insurance coverage they deal with giving short 3 times per week dialysis here in the US. So we speed up the blood flow to make up for lack of time . As Dr. Agar writes in his article, this is a very poor and dangerous way to do dialysis. The answer is slower blood flow and MORE TIME ON MACHINE.
For those who can , try to get more time on machine in- center and ask to slow down the blood speed. For those at home ,DO IT YOURSELVES . Nxstage for example will do fine at 340 blood speed as it is VOLUME driven rather than speed of blood. (My wife for example gets a KT/V(FOR WHAT ITS WORTH) of 3.24 running at 340 blood speed. Her urea reduction even on Nxstage is near 65%.) IT CAN BE DONE. For those on the other machine , work with your team to come up with a formula that allows enough time on machine to allow you to slow down the blood speed and still get adaquate dialysis.
Remember , KT/V while flawed still comes down to either speeding up blood which increases K or adding TIME which increases T . Dr. Agar writes this simply and his point is in the US we go for K which causes morbidity and mortality while in other countries they raise T which saves fistulas and lives.
So which is it? Are you going to be a K or a T?? K KILLS while T Trumps all.
Just a note on Time. Dr. Agar writes that the minimum time on machine should be over 10% of total weekly time or about 17 hours per week.
If I can help anyone here to get your team to do this with you, please ask. This may be the biggest thing you can do for your health on dialysis.
BE well.
-
In the UK, 12 hours a week is standard and almost impossible to get increase on shifts unless really ill. We get a minimum amount rather than an ideal amount.
Keep us alive but not keep us well!
My pump speed varies between 290-340 on the whole, though I've seen those that ramp it up to 400...
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I have been trying to sell this idea for years to the D caregivers and got thrown out of one clinic over this issue. Their rational is if the fistula can handle the speed they are going to run it along with shorter times.
Experience has shown that running longer (at least 4 hrs) with a 350 or less flow and smaller needles (15 ga) is the best combination for longer graph survival and is easier on the entire vascular system.
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The "Americam WAY" is ingrained in the system due to the medicare regulations and the for profit companies that provide the bare minimum dialysis for their money. Speed it up and get patients off faster to make more money. It is sad.
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I'm interested in all things fistula wise at the mo as I will soon be having one.
One patient on my unit (UK) is very proud of the fact that he maintains a pump speed of 600 (I have double-checked this) throughout his dialysis sessions and I think has done for the past couple of years, maybe longer.
Wouldn't most neph consultants have thought about the benefits/ pitfalls of such a pump speed before prescribing it? I want to share this research with my fellow patient who I care a lot about but don't wish to cause trouble.
(He cannot access IHD because of his poor eye-sight)
Very grateful to have Obsidianom on here looking out for us all..
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Thank you for your kind words.
The following is the article that shows how faster blood speeds damage fistulas at the venous return due to turbulance effecting the vessel walls .
http://www.ncbi.nlm.nih.gov/pubmed/23448433#