Doc reduces dialysate flow, what's yours?

[circleNthedrain]

I've been going to the same unit for over 2 1/2 years and recently you can really feel all the cutbacks.  i have always run at 400 blood pump speed and 800 dialysate flow.  Yesterday they changed my dialysate flow to 600.  When I asked why, they said it was Doctors orders for all his patients.  WTH?  Anybody else experience this?  What flows do you run at?  Needless to say, I'm not happy and plan to talk to him about it as soon as I SEE him.

[dwcrawford]

Bill, I only run at 250 but then I still have only one needle.  I don't really understand but I'd ask Zach or somebody with as much experience and knowlege as you have.  How will that save them money? 

[BigSky]

I run at 800 dialysate flow.

Some people I know run as low as 500.  I would ask him to what medical reasoning he did that and if your labs justify such a change.

[circleNthedrain]

Dan, I think you are talking about blood pump speed but I am talking about dialysate pump speed.  Less dialysate = less money.  With some of the chicken sh** cutbacks I've seen lately, I'm surprised they keep the lights on!

Thanks BigSky, you can bet I'll be asking some questions!

[dwcrawford]

oops.  I told you the other night that I know nothing...

actually I'm not really sure what either of them are but don't take any less or more than you need.

[del]

On a 7 hour nocturnal run hubby has a 250 pump speed and a dialysate flow of 300. 

[Zach]

I'm at 800 dialysate flow (Q_d).  But 700 seems to be the norm at my unit.
This refers to conventional 3 x week hemodialysis (3.5 - 5 hours)

I've been at some units where the dialysate flow was set at 1,000.  It's rarely used, but for higher blood pump speeds (Q_b) of 500 or greater, it may be the most efficient for high-flux.

But remember, not all dialyzers are made for those higher blood pump speeds.  And there are many factors that lead to better clearances (time on the machine is perhaps most important).

In high-flux, dialysate flow twice the speed of the blood flow is perhaps considered the most efficient for the removal of urea, etc. Dialysate flow 1.5 x blood pump speed is a little less efficient, but perhaps not significantly.

Here's a look at the newer 2008K² hemodialysis machine with it's dialysate "AutoFlow."
http://www.2008k2.com/2008k2_AutoFlow.html

Make sure you pay close attention to your monthly chemistries for any significant changes and then meet with your Nephrologist.

[Hemodoc]

My unit did the same.  It is entirely a cost saving issue for water usage. However, since I was on self care in unit, I put mine back up to 800 and it did make over a 10% difference in my clearances.  The squeeky wheel gets the grease.  See what you clearances are at 600 compared to 800.  If it drops, I would insist on returning to 800.  Like I said, since I set up my own machine in unit, not much they were going to do about it anyway in my case.

So, it is all about a lower water bill and America's concept of adequate instead of optimal dialysis.  Just one more example.

[circleNthedrain]

Thanks Hemodoc!  This was exactly my feeling on this and I would think it would have to reduce blood clearances...you can bet I will be watching mine very closely.  Lately more than ever, the bottom line seems to be the only concern.  "Adequate instead of optimal" is a very sorry state of affairs.

[circleNthedrain]

Sorry Zach....I lost my reply to you!!  Thanks for all the interesting information, I had hoped you would reply to this.  I am on 3X a week for 3 hours.  Recently we changed from Polyflux 210H dialyzer to Gambro Revaclear high-flux dialyzer.  They say the Polyflux will no longer be available in the US. I really don't like it when they make changes (25% dialysate flow reduction) without any explanation offered.  I will be keeping a very close eye on my labs.  Thanks again Zach!

"

[kidneyless_In_PA]

my blood flow rate was put up to 350 a few months back.. I am on 3 1/2 hours. 3 times a week.

[BigSky]

You might ask them why they didnt do a Kt/V the day they changed your flow rate.  Nothing is worse than having filters or flow rates changed and having to wait weeks to find out at the next regular lab draw if your Kt/V is where its suppose to be at or if you were getting piss poor dialysis during that whole time since they changed something.

[kidneyless_In_PA]

they don't care about us

[Hemodoc]

kt/v doesn't tell the whole story since they are only looking at the minimal standards, not optimizing all factors for the patients.  This is one for the pocket book of the unit owners, pure and simple.

[circleNthedrain]

Well, I'm back to 800 dialysate flow!  Yay!  My kt/v dropped from 1.66 to 1.55 since they reduced the flow to 600 a little over a month ago.  This is lower than it's ever been. Grrr!!  I'm pushing for 4 hours instead of 3, and so far I'm up to 3 1/2.  Gotta take our little victories where we can. 

[Zach]

Well, I'm back to 800 dialysate flow!  Yay!  My kt/v dropped from 1.66 to 1.55 since they reduced the flow to 600 a little over a month ago.  This is lower than it's ever been. Grrr!!  I'm pushing for 4 hours instead of 3, and so far I'm up to 3 1/2.  Gotta take our little victories where we can.

[paddbear0000]

When i first started, they started me out at 800 dialysate flow, but it gave me massive headaches and made me sick. We found that the highest I can tolerate is 600, but i'm a small person, so that may make a difference. My clearances could be better, but I feel less sick at the slower rate than I do at the higher rate!

[circleNthedrain]

Hey paddbear...with dialysis you have to experiment to find what works best for you.  Glad you found the slower speed helps!

[paddbear0000]

My URR isn't great, but it's the lesser of 2 evils!

[Lillupie]

Can i ask why do you only have one needle? How does that work? I never heard of someone only having one needle on dialysis.

Lisa

Bill, I only run at 250 but then I still have only one needle.  I don't really understand but I'd ask Zach or somebody with as much experience and knowlege as you have.  How will that save them money?

[circleNthedrain]

Hi Lisa...I think Dan was still using one tube from his perma-cath and one needle in his fistula.  This is a common practice while waiting for a fistula to mature.  You could PM him to find out for sure.