Baxter is disappearing. Do you know why? Why is Fresenius taking over?

[WishIKnew]

So, many of you are much better than I at knowing, getting to the bottom of, finding out the behind the scenes motives of changes in the dialysis world. Maybe you can shed some light...

Here in NE Ohio Baxter was a main supplier.  The clinics taught and used Baxter machines for PD and all of the hospitals were taught and equipped with Baxter products.  Now the clinics seem to all have switched to Fresenius equipment.  I have sought to remain on Baxter and have been told it is impossible, "It will all be Fresenius here soon".  During a recent hospital stay, there was not one nurse on my floor who knew how to connect my adapter so my Fresenius catheter could be used with their Baxter dialysis bags.  It's a nightmare!!!!! 

I've called Baxter and asked if there were any clinics in my general area which use Baxter, because I was willing to switch!  They said they could not answer my question.  Odd, I think, because you would think they'd try to keep their customers.

There has got to be big politicking or money behind these changes.  Do you know what's happening, or can you speculate?   I'd love your ideas on this!

[dh514]

If you google baxter and fresenius you can find several  articles on their court battle.

[WishIKnew]

Duh, why didn't I think of that!

[greg10]

Fresenius Wins Patent Case Against Baxter

"This is a victory not only for Fresenius Medical Care, but for the thousands of individuals undergoing dialysis because of chronic kidney failure who will continue to have access to Fresenius Medical Care's unparalleled track record of safety and performance for its services, equipment and supplies."

August 2, 2010


OAKLAND, Calif.—A  Northern District of California jury last week rejected claims of patent infringement made by Baxter Healthcare Corporation and DEKA Products, Ltd, against the Liberty Peritoneal Dialysis (PD) Cycler designed and produced by its wholly owned subsidiary, Fresenius Medical Care Holdings, Inc. The patents related to PD cycler pump design.

Baxter had claimed that Fresenius Medical Care's Liberty PD machine infringed a Baxter and a DEKA patent, which both involve the design of the pump that fills and drains PD solution from patients. The DEKA patent is most closely related to Baxter's Home Choice PD cycler that was originally developed by DEKA in the late 1980s. Fresenius Medical Care demonstrated that the Liberty Cycler utilizes mechanical means to operate the pump that fills and drains patients and was not a copy of Baxter's Home Choice cycler.

The jury returned a unanimous verdict on July 28 of no infringement on every count after deliberating less than a day in Oakland, Calif., following a nearly four week trial.

"We are gratified that the jury has sided with Fresenius Medical Care in its defense of its Liberty Cycler against charges of patent infringement. We knew all along that these claims were baseless and without merit," said Juanita Brooks, Fish & Richardson principal and lead trial counsel on the case. "This is a victory not only for Fresenius Medical Care, but for the thousands of individuals undergoing dialysis because of chronic kidney failure who will continue to have access to Fresenius Medical Care's unparalleled track record of safety and performance for its services, equipment and supplies."

This jury verdict comes on the heels of a different win for Fresenius Medical Care related to other pending litigation with Baxter. On July 20, 2010, the Patent Office's Board of Patent Appeals and Interferences dismissed Baxter's request for a rehearing of the appeal of the reexamination decision invalidating the claims of the sole surviving patent, 5,247,434, in litigation over Baxter's patents on hemodialysis (HD) machines with touch screens. Therefore, the final outcome of the Patent Office reexamination proceeding is that the '434 patent claims in suit are unpatentable and subject to cancellation. Two other patents (5,744,027 and 6,284,131) in the 2006 HD case were previously found invalid by the U.S. Court of Appeals for the Federal Circuit and in parallel reexamination proceedings. Baxter may file further appeals on the '434 patent. This case and the reexam proceedings were also handled by Fish & Richardson.

"We are disappointed in the jury’s verdict, given the strong evidence presented to the jury," Baxter said in a statement. "We are evaluating our options to appeal this decision, in order to protect the unique innovation in Baxter’s HomeChoice peritoneal dialysis cycler."

[WishIKnew]

Thanks guys, you've shed light on the story behind my problem. 

Where could I find statistics which compare patient satisfaction and infection rates between Baxter HomeChoice users and Fresenius Liberty users?  Any suggestions?

[RightSide]

Here in NE Ohio Baxter was a main supplier.  The clinics taught and used Baxter machines for PD and all of the hospitals were taught and equipped with Baxter products.  Now the clinics seem to all have switched to Fresenius equipment.  I have sought to remain on Baxter and have been told it is impossible, "It will all be Fresenius here soon".  During a recent hospital stay, there was not one nurse on my floor who knew how to connect my adapter so my Fresenius catheter could be used with their Baxter dialysis bags.  It's a nightmare!!!!! 

By now, you've already read about the court battle.

With my clinic, Fresenius is upping the ante.  My clinic also dumped Baxter for Fresenius, even though in my judgment I was doing better with Baxter dialyzers than I did with Fresenius dialyzers.  The grapevine is that the management of our clinic did that to ingratiate themselves with Fresenius, in anticipation that Fresenius is going to take over the clinic entirely.

[Zach]

Fresenius is a very successful, vertically integrated company.

Not only do they own dialysis centers, machines and filters, Fresenius owns the blood lab, Spectra, and the medications Hectoral and PhosLo.

They also act as a distributor for a lot of the other supplies needed for dialysis:  saline bags, bloodlines, needles & syringes, gauzes, band-aids, cleansers, gloves, etc.

[greg10]

Baxter may have tried to buy Fresenius Medical Care (FMC) in 2008 but the parent company, Fresenius SE, probably rejected any offers.  Fresenius SE is in turn majority owned by the Else Kröner-Fresenius-Foundation which is a support to the medical-scientific and medical-humanitarian projects designed, non-profit foundation .  The EKFS counts for endowment of the five largest private foundations in Germany.

http://translate.google.com/translate?hl=en&sl=de&tl=en&u=http%3A%2F%2Fde.wikipedia.org%2Fwiki%2FElse_Kr%25C3%25B6ner-Fresenius-Stiftung

In her will lay the foundation Else Kröner purpose as follows:
 "(1) The Foundation will promote medical science, giving priority to the areas of research and treatment of diseases, including the development of devices and drugs, for example of artificial kidneys .

"Fresenius SE owned approximately 35.6% of the ordinary voting shares of FMC. Fresenius Medical Care Management, the general partner of FMC, is a wholly-owned subsidiary of Fresenius SE. Through its ownership of the general partner, Fresenius SE is able to exercise de facto management control of FMC"

http://www.forbes.com/2008/04/18/fresenius-medical-care-markets-equity-cx_jm_0418markets15.html

Fresenius Medical Device Company Intelligence Report


Fresenius SE is an international healthcare group providing products and services for dialysis, hospital and outpatient medical care. In addition, Fresenius specialises in hospital operations and offers hospital engineering and services for hospitals and other healthcare facilities.

 The group comprises the business segments Fresenius Medical Care (FMC), Fresenius Kabi, Fresenius Helios and Fresenius Vamed, all of which are legally-independent entities managed by the operating parent company Fresenius SE. This group structure has been in place since 1st January 2008. Prior to this date, Fresenius Helios and Fresenius Vamed formed a single business segment called Fresenius ProServe.

 Fresenius Medical Care (FMC) concentrates on dialysis care, and the manufacture and marketing of products for the treatment of patients with end-stage renal disease (ESRD).
 Fresenius Kabi specialises in the production and sale of products for infusion therapy and clinical nutrition, as well as intravenously administered generic drugs (IV drugs) and transfusion technology.

Fresenius Helios owns and operates 61 private German hospitals. In addition to 42 acute care hospitals, including five maximum care clinics in Berlin-Buch, Erfurt, Krefeld, Schwerin and Wuppertal, the group has 19 post-acute care clinics. 24 medical centres and four nursing homes are also affiliated with Helios.
 Fresenius Vamed provides engineering and services for hospitals and other healthcare facilities internationally.

 The segment Corporate/Other consists of the holding activities of Fresenius SE, the IT service provider Fresenius Netcare and Fresenius Biotech. Fresenius Biotech is active in research and development in the field of antibody therapies.

 As of 31st December 2009, Fresenius SE owned approximately 35.6% of the ordinary voting shares of FMC. Fresenius Medical Care Management, the general partner of FMC, is a wholly-owned subsidiary of Fresenius SE. Through its ownership of the general partner, Fresenius SE is able to exercise de facto management control of FMC. Due to this structure, FMC is fullyconsolidated in the consolidated financial statements of the Fresenius Group. 

 Fresenius SE holds 100% of the management companies of the business segments Fresenius Kabi, Fresenius Helio and Fresenius Vamed.

 As of 31st December 2009, the Else Kröner-Fresenius Foundation was the largest shareholder of Fresenius SE, holding approximately 58% of the voting shares.

 This report mainly concentrates on the activities and performances of FMC, the largest dialysis company in the world, and Fresenius Kabi, which holds leading positions in Europe, Asia-Pacific, Latin America and South Africa.

[Lillupie]

ok,
 
 WishIknew, Im kind of confused?? Do you mean that you have a Baxter cathater?? And Everyone seems to be using Fresinus? Or do you have a Fresunius cathater and everyone is using Baxter?

I have wondered this to a degree too. Here is my thing. This is what I heard. Fresenius is cheaper then Baxter. It is a cost thing. At the moment I HATE, HATE, HATE Baxter with the passion. I have even threaten to leave them if I have any more problems. (I have ranted and raved about how much I hate Baxter on here in earlier forums).

 My clinic in Detroit, Michigan will not go to Fresenius because they say Baxter is a superior product and is easier for people to learn. On my road trip across the United States, I had to get supplies from a Fresenius clinic in New Mexico (that is all Albequere, NM had). The nurse there said "Baxter is easier and more freindlier to use, but I know who pays my bills". A nurse in Florida, when I was in the hospital put me on a funny looking Fresenius machine, and she told me Freseius is wayy cheaper then Baxter and does the same thing.

So, I think with all the budget cuts across the board and all this bundling stuff, I can see why clinics and hospitals would switch to Fresinus. that is just my 

Lisa

[Bill Peckham]

Fresenius is a very successful, vertically integrated company.

Not only do they own dialysis centers, machines and filters, Fresenius owns the blood lab, Spectra, and the medications Hectoral and PhosLo.

They also act as a distributor for a lot of the other supplies needed for dialysis:  saline bags, bloodlines, needles & syringes, gauzes, band-aids, cleansers, gloves, etc.

 

Right. The worry is that this stifles innovation. Look at the home hemodialysis device market in the US. Baxter has been working with DEKA to bring a new HHD machine to market based on the Aksys technology but look at the market they are trying to enter. It is unlikely that you could sell a HHD device to FMC because they have the baby K and are working on the sorbent systems from the Renal Solutions merger.

This means that if you want to introduce a new HHD device in the US market there is only one large potential customer - DaVita - so good luck with any margin. It's the duopoly in the provision of dialysis that is a problem; if FMC was one of four large dialysis providers (the world pre 2004) their vertical integration would be less of a problem.

The other issue is what happens if there is a manufacturing issue - right now with everyone using FMC saline what is suppose to happen if there is a saline recall?

[WishIKnew]

I love hearing  all of your input and information on this topic!  I'm learning a lot!

lillupie I was happily and successfully on Baxter and was forced to switch to Fresinius which I'm having all kinds of problems with.

Today the sales rep for our area is driving here (over 2 hour drive for her) and one of my PD nurses and the sales rep are coming to my home to check on why I'm having so many problems.  I have been sick (peritonitis, hospital, etc) ever since I switched. 

Anyway, keep your thoughts and opinions coming.  You all are a fount on knowledge!!!!!

I'm off to clean my house!

[Jie]

Fresenius is a very successful, vertically integrated company.

Not only do they own dialysis centers, machines and filters, Fresenius owns the blood lab, Spectra, and the medications Hectoral and PhosLo.

They also act as a distributor for a lot of the other supplies needed for dialysis:  saline bags, bloodlines, needles & syringes, gauzes, band-aids, cleansers, gloves, etc.

Fresenius also is very good to make money. The charge of Fresenius to my insurance during the last two years for my PD is almost double (100% increase). What a successful co.! With such cost increase rate, everyone with dialysis patients will be out of business in a few years!

[sullidog]

From what my center told me baxter machines are just a "bandade" meaning the machines did not give as good of dialysis as Fresenius ones do. From using both machines I can tell you that Fresenius seems to be better at dialysis then baxter because they are stronger, I had trouble getting use to the machines as I was crashing more with the new machines, but after a few weeks my body has gotten use to them.
Troy

[WishIKnew]

What do you mean crashing more? 

Still really struggling with my Fresenius machine - it alarms all the time!!!!!

[Riki]

I was on a Fresenius machine when I was on dialysis the first time.  This was the 6ft tall thing, that you hung 6 bags of dineal a night, and was all gravity based.  We used Baxter dineal, but I think the rest of the supplies were Fresenius.  That was in the early 90s, and you had to spike the bags, and at the end of the night, I had to clamp off the tubing that connected to my catheter, and cut the extension line with a pair of scissors.  My catherter was leur-lok, which is the predecessor to saf-lok, which is what my last catheter and most of the dineal bags are now, I think.  There were no mini caps then.. once you were on the machine, you were on it.

I liked the Home Choice machine.  After being on the Fresenius monstrosity, the Home Choice was an amazing piece of technology.  I mean, it fits in a suitcase, and will fit under the seat on an airplane!  I couldn't travel at all with the old one.

None of that matters anymore, though, cuz I hook up to a Gambro machine 3 times a week now.. *L*

[cath-hater]

I've been with Fresenius for some time now. I've been with them so long, that I went through 2 machine upgrades.  All the machines that I had came with it's own stand on wheels allowing you to roll it around.  I have to say I really like Fresenius. The machines are easy to program.  You can change the program during exchanges if you change your mind about something.  From what I hear about the Baxter Homechoice, once that thing is programmed, you're set and that's it.  To reprogram it, you have to stop dialyzing and start all over.  When I was in the hospital, they use Baxter and that's what the nurse told me.  They had made a mistake and didn't program long enough dwell cycles.  I asked her if they can change it.  She said NO, because they would have to stop and start all over.  I don't know if that's true and that she was just being lazy, but that makes a big difference to me.

Sometimes when I am dialyzing, I change my mind and decide to add on an extra exchange or maybe cut it short by removing an exchange or maybe I want to increase or decrease dwell time on a certain exchange, my Fresenius machine allows me to make those changes on the spot.

I don't have to worry about space because it comes with it's own stand.  They have drain lines that go right to the tub/toilet/sink.  They offer patient extension lines.  They have the Stay-Safe caps that limit "open time" exposure.  They offer multiple disconnect extensions.  You can put all of your bags ontop of the machine itself.  I see how Baxter patients put only 1 bag on top of the machine and then 1 or 2 bags to the side or on bottom shelf or something.  Just seems so scattered to me.

If you're on Baxter and prefer it, that's great. I'm not calling you a dummy or anything for choosing it.  Just personally, I think Fresenius is better for me. My 2 cents.

[WishIKnew]

cath=hater - I am really glad to hear someone likes the Fresenius machine!  How many alarms do you typically get  a night?  How does your husband deal with the noisiness of the machine?  Have you gotten peritonitis at all?

The bag issue you mention is different for me.  I can't put more than 1 bag on the heating element or it alarms - sometimes it alarms with just one bag there.  On Baxter I needed two bags, one went on top and one laid beside the machine.  But with Fresenius I need three bags because the at 100L smaller than Baxter, and there is no room on the rolling table so I have to hang two bags, just like you saw for other Baxter users.  And getting the little cappy things down out of the neck of the bags is frustrating!  Do you have to do that?

And set up time that used to take 3 minutes now can take up to 20 minutes....

I guess it's all in what we are used to and I will, over time, get used to my new machine.  It does keep me alive!   I'm glad you replied because I need to hear the positive so I can get my head in a better place.

I did not like the new machine before I even started it because I did not like that, I , the patient, did not have a voice in the decision......

[cath-hater]

Wish -
Are you using the Fresenius Liberty cycler?  The one with the touchscreen? That one looks nice, but I think it's their latest unit.  With every new thing, they come with their own set of problems. Takes some time for them to get the kinks out, just like with any new model of anything.  I guess with the model you got, it's similar to the Baxter one, which only allows 1 bag on the unit itself.  My model uses gravity to get solution in and out of me, so it's noise-less during those steps.  The only time it makes noise is when it's pumping the solution from drainbag to my tub.  The stand that it comes with places the machine really high about my bed level and the drain bag well below, so gravity can do it's thing.  I can't see this machine working for someone who sleeps on a bunkbed for example.

I'm sure the bags are the same no matter which machine you use. To open up the bags, i just break the cones and that's it.  Once in awhile I'll  notice the solution isn't draining from one of the bags, usually because I didn't break the cone properly - but nothing major.

As for alarms at night, I might get 1 or 2. Most nights, I sleep right through. I guess I don't roll around alot at night.  On rare nights that I might get up to 5 alarms, I know something else is wrong other than just me rolling over my tube.  It's usually a kink in the line somewhere other than me or the machine is having trouble getting more solution in because of not breaking the cone properly. I get up and do alittle inspection and usually find the solution pretty quick.

Eventhough my machine works on a scale system and one may think that a slight touch or movement could throw off the numbers, but no problem there. It's actually pretty smart. For instance, as I am draining and the machine is measuring the ml's coming out and I happen to knock the machine to move it or roll it - the count jumps but then goes back to normal continuing the count where it left off counting. It's something you have to see to understand I think.

There was one time when my machine kept giving me a scale alarm no matter what. I didn't touch it or move it or anything, but kept giving me scale alarms for 2 days. That's when I knew it was the machine and I had to get it replaced. Was severely interfering with my dialysis.  If you're getting so many alarms at night, you have to find out why.  If you can't seem to figure it out and know for sure that you're doing everything correct, then it very well could be a defective machine.

Find out if your clinic offers the Newton machine. Fresenius claims it's their most advance system.  If you're not getting enough dialysis in with your current machine, switching to the Newton couldn't hurt. Setting up the tubing is a cinch. Takes me about 2 minutes these days.  The flushing can be a little tricky but nothing major. Takes about 5 minutes.  My fill is pretty quick.  My drain is rather fast also, but I give it 30 minutes during drain cycles because I like to make sure I get every little drop out before next fill.  If I'm standing during drains, it goes real quick. One thing about filling is that you have to be sitting or lying down because of the gravity thing. So you couldn't be vacuuming or something while filling.

MY experiences are only with the Newton machines, not the Liberty. So I couldn't suggest any machine advice.  But like I said before, Fresenius products can be most accommodating.  You can pause in between exchanges. So say you want to go out for dinner but want to get in an exchange before you leave.  You just program it to pause after the fill and you have all the time in the world to go do whatever. You can set up to 4 pauses.  With the multiple disconnect extension, you could litterally disconnect after every exchange if you wanted.  For those nightly trips to the bathroom, you can request the patient extender line (10ft). The extra 10ft along with the existing line should give you a good 20 feet of cord to wander from the cycler.

I feel like I'm rambling, and could go ON and ON. Instead, if you have ANY questions, just let me know.

[WishIKnew]

I have the the Liberty cycler.

I love all of your information and enthusiasm!  It sounds like you've got it all figured out and have the machine working for you instead of you cow towing to it.  It gives me great hope that I will eventually really appreciate it's good features!  I guess change is just hard!

Thanks!!!!!

[Jie]

If one gets alarm one or two a night, it is terrible. I used Baxter for close to two years, and only a few nights I had alarms. If the Fresenius machine has so many things in it, it may be difficult for travel? Funny, my clinic is Fresenius, but it uses Baxter machines and supplies.

[Quickfeet]

When they switched you to fresenius they should have given you an adapter for baxter and explained how to put it on. I was given an adapter and told to take it with me on trips because most hospitals use baxter.

[cath-hater]

If one gets alarm one or two a night, it is terrible. I used Baxter for close to two years, and only a few nights I had alarms. If the Fresenius machine has so many things in it, it may be difficult for travel? Funny, my clinic is Fresenius, but it uses Baxter machines and supplies.

Traveling is not too bad. True you have an extra suitcase for the stand, but it's not too bad. You would bring along all the stuff that a Baxter patient would bring (caps, tubing, mask, tape, gauze, etc..)  The only thing extra I see is the stand, but I know the Liberty Cycler sits on a table like the Homechoice - and no stand is needed.

[WishIKnew]

I just returned home today from a 7 day hospital stay.  I had my third bout of peritonitis since mid March.  Coincidentally, I began the Fresenius machine three days prior to my first bout of peritonitis.  This was a BAD one - gram negative, ect.  If I get sick again I loose my PD cath and have to do hemo.  I have refused to use the machine and will be doing manual exchanges from now on.  The problems may not be machine related, but I feel like every time I use it I'm playing Russian Roulette!  I'm terrified of getting sick again!!!!     BOO Liberty Cycler!!!

[Bill Peckham]

I just returned home today from a 7 day hospital stay.  I had my third bout of peritonitis since mid March.  Coincidentally, I began the Fresenius machine three days prior to my first bout of peritonitis.  This was a BAD one - gram negative, ect.  If I get sick again I loose my PD cath and have to do hemo.  I have refused to use the machine and will be doing manual exchanges from now on.  The problems may not be machine related, but I feel like every time I use it I'm playing Russian Roulette!  I'm terrified of getting sick again!!!!     BOO Liberty Cycler!!!

I don't know too much about PD but I am not sure you are reaching the right conclusion based on what you're saying.

What if, back in March, you hadn't switch cyclers and you had the same series of infections? You'd have to consider other issues -
and antibiotic treatment for people who are using CAPD is tricky  http://www.ndt-educational.org/images/03Piraino4237ISPD.pdf  (page 118). I'm sorry if you've gone through all this on another thread but why wouldn't you think this is an issue with the antibiotics not completing the job after the first bout of peritonitis?

3 bouts of peritonitis in 6 weeks , on top of everything else, yeesh. When you switched cyclers was the training intensive? were there new procedures to learn, big difference between platforms? again sorry if I missed this already being discussed.

[Mike_NC]

I just returned home today from a 7 day hospital stay.  I had my third bout of peritonitis since mid March.  Coincidentally, I began the Fresenius machine three days prior to my first bout of peritonitis.  This was a BAD one - gram negative, ect.  If I get sick again I loose my PD cath and have to do hemo.  I have refused to use the machine and will be doing manual exchanges from now on.  The problems may not be machine related, but I feel like every time I use it I'm playing Russian Roulette!  I'm terrified of getting sick again!!!!     BOO Liberty Cycler!!!

I don't know too much about PD but I am not sure you are reaching the right conclusion based on what you're saying.

What if, back in March, you hadn't switch cyclers and you had the same series of infections? You'd have to consider other issues -
and antibiotic treatment for people who are using CAPD is tricky  http://www.ndt-educational.org/images/03Piraino4237ISPD.pdf  (page 118). I'm sorry if you've gone through all this on another thread but why wouldn't you think this is an issue with the antibiotics not completing the job after the first bout of peritonitis?

3 bouts of peritonitis in 6 weeks , on top of everything else, yeesh. When you switched cyclers was the training intensive? were there new procedures to learn, big difference between platforms? again sorry if I missed this already being discussed.

Bill, I too have been switched to the Liberty cycler as WishIKnew has been. Her circumstances could be coincidence in terms of timing, but as I told her on another thread, there is a good reason for concern. At my last visit to the clinic for labs, I asked a simple question regarding peritonitis. I have been doing PD for almost 4 years and until Feb 1st I had a Baxter cycler (Far superior to the Liberty in my opinion) Anyway, what I was asking my nurse was whether it was unusual for me to not have had peritonitis since starting dialysis. That lead to a discussion that made me very wary of the Liberty cycler and the new Fresenius solutions. My nurse informed me that the number of cases of peritonitis has increased since switching people over to the Liberty cycler. More cases, more often than she has seen in 18 years as a PD nurse. The 5 most recent cases were gram negative which means the infection is caused by something internal, like the bowels, rather than gram positive , which would point to outside contamination such as mishandling the equipment. 3 of the 5 were hospitalized at that time and 2 had lost their catheters due to the infection. I use 2-1.5% bags at night and if I find that I'm retaining fluid, then I was instructed to use 2-2.5% bags or 1-1.5% and 1-2.5% to help remove the excess fluid. On the Baxter cycler, using Baxter solutions, I could do this with NO adverse effects. With the Liberty/Fresenius setup there is a significant difference in what happens. Using 1 bag of each 1.5% and 2.5% , the following day I find that I am quite constipated. When I informed my Dr of the difference (during the peritonitis convo) he found it quite interesting, because it seems the solutions could be of a different make up and that Fresenius solutions could be stronger. I have skipped numerous nights of dialysis since starting with the Liberty and I think that may be my saving grace, in terms of not contracting peritonitis. My nurses are aware of what I do and while they do not approve, they do understand my justifiable concern. There is currently an investigation within my clinic to find out what is going on. I myself intend to perform my own investigation as far as I possibly can. I told the nurses when I was being trained that the Liberty cycler seemed to be an unfinished thought. I still stand by that statement to this day. A Fresenius representative pretty much said the same thing without being a direct quote of my "unfinished thought" statement. I have been through 3 machines and will be getting yet another one on June 9. (All since Feb 1st) This new one is supposed to have upgraded software and I will be part of a trial for the new machine. It's suppose to be less sensitive (hopefully cutting down on alarms) and will have a manual drain which is something I need because I don't drain properly due to catheter position. I hold little faith in Fresenius decision making and the quality of care is degraded by the change from Baxter to Fresenius. As time goes on I feel as though I will be forced to change clinics to attain the quality of Baxter products and support. The ONLY reason I have not yet switched clinics is for financial reasons. The only clinics that offer Baxter products are at least an hour drive from where I am and being on a very limited disability income, it is not feasible right now. I know this was way longer and may have veered off the subject but I feel strongly that Fresenius is looking out for themselves vs looking out for the patients under their care. I truly believe it comes down to the all mighty dollar. As I said in the other thread...with my clinic it's either go Fresenius, or go away. Bottom line Baxter > Fresenius.