Changing blood flow rate to improve lab results

[Treasure]

Greetings, all. I've given up on NxStage (again) and have gone back to in-center. I noticed during my last lab draw that the clinic was running me at a higher Blood Flow Rate than usual (my usual is 450 and they had me cranked up to 475--which I have never run at). When I asked why they had upped my BFR, I was told it was due to labs. I asked the nurse isn't that trying to cheat the system, to make it appear that I have better clearances than I do, and she gave a very non-commital answer and then lowered by BFR to it's normal setting. This was pretty peculiar since my clearances have always been good enough for their minimums (though usually not enough to keep this very active dialysis patient feeling "healthy.")

Has anyone else noticed their clinics running patients at higher-than-normal BFR on lab days? I think it's unethical to artificially boost your numbers this way. If I catch them running me at a higher BFR than usual on another lab day, I will definitely start making some noise about it to the proper authorities.

Ever-vigilant Treasure

[Simon Dog]

I asked the nurse isn't that trying to cheat the system, to make it appear that I have better clearances than I do

It is not cheating, as a higher BFR will give better clearance.

Check the filter they are using for you - the Fresenius ones come in 4 sizes (160, 180, 200 and 250).   A bigger filter will result in better clearance.    Fresenius requires that you fail clearance at 4 hours 30 minutes before your MD is allowed to prescribe a 200 or a 250 due to the extra co$t.   Generally, heavier patients get bigger filters.  I am a bit over 100kg and get a 180 when I am in-center (usually do it at home/NxStage), but only after asking my MD to increase it from a 160.

Why did you give up on NxStage?

[Charlie B53]

Good catch.  I will have to start paying attention.

I know my clinic usually starts me at 450 but repeated alarms they slow the flow until getting only an occassional single 'beep'.  They blame it on my cath.  My fistula hasn't matured well enough to be used.  Vascular has me scheduled to go in, look and see if he can tie off sorralaries and direct the flow somewhat better.

[GA_DAWG]

Thought only the doctor could order your flow to be changed upward. I know they sometimes lower it if they are having problems with a fistula or catheter. I have also been told there is a limit on how high a blood flow can be based on the size of the filter.

[JW77]

As far as I know going by clearance ISN"T the end all.  Adequate clearance is needed.  Higher blood flow rates, in the long term can be damaging to the access, and the heart.  Its getting the balance right for your weight/mass etc and diet and any remaining clearance from kidney function if any at all.

This is why nocturnal, with a low BFR and long hours is the gentlest form of dialysis for the heart and usually gives the best clearance.

[Simon Dog]

Thought only the doctor could order your flow to be changed upward. I know they sometimes lower it if they are having problems with a fistula or catheter. I have also been told there is a limit on how high a blood flow can be based on the size of the filter.

I know the general rule is 250 for a 17ga needle; 350 for a 16ga; and 450 for a 15ga.