New dialysate protocol

[tyefly]

Clinic today....    I was informed that they would like everyone to start using K2 or evern K3 dialysate....  most of us use K1 to take potassium out of our system....  K1 takes the most and K2 takes less and so forth....  they was all of us to start using K2 or K3 and start restricting our diet so that we dont have that much potassium to take off....  My labs are great with potassium....   and I guess since I dont really watch what I eat so much  they want me to eat nothing that has potassium and then us the lower potassium remover dialysate.....  I am thinking   I am doing fine with using the K1  why would I want to stop eating oranges and fruit and this and that when I can continue using the K1 and have great labs.....  If I stop using the K1 and switch to the K2 or K3  my labs will be bad  ( higher potassium ) and I will miss out on eating what I want to eat.....   where is the logic in that.....Its not broke  dont try to fix it ......   I wonder if the K2 or the K3 are cheaper....??

[calypso]

My guess is that if you use the stronger solution your potassium can drop too low during or shortly after treatment if you happen to eat less potassium that day. Also your potassium may rise too high if you eat high potassium foods and need to skip a treatment for some reason some day. (problems with the access...etc.)

[Rerun]

I know what you mean!  My old dialysis center did 1K and life was pretty good with my potassium.  I could even get away with drinking a little milk.  Then when I moved, the new place acted like they had never heard of 1K .  They only have 2K and 3K. 

They said that 1K was dangerous!  Well, my understanding is high potassium is just as dangerous and low potassium so I'll take my chances with the 1K.  I fought for it and they finally admitted they used it in the hospital but that's all. 

So, I'm stuck on 2K with a more restricted diet.

Next they will probably take away our phosphorus binders and say "you just have to eat less phosphorous"!!!

Dumb is Dumb!!!!

[noahvale]

**

[PatDowns]

So, I'm stuck on 2K with a more restricted diet.
- No, you have other options to get in more dialysis so your diet can be more liberalized.  You have made the choice not to do so.

Next they will probably take away our phosphorus binders and say "you just have to eat less phosphorous"!!! - This comment is "Dumb is Dumb."   

Dumb is Dumb!!!!  

[tyefly]

I am currently doing 48 hrs a week of dialysis.....  I have always used 1K...  labs run around 4 - 5 pot...  Since I have only been doing nocturnal for 40 days  I guess I better see how my labs are in a month or so....   then maybe let them make ajustments..... 

[lola]

so today Otto comes home and tells me they gave him k3 instead of k2, is this bad? They said he'd be OK but HELLO this is the 2nd  in 3 months, a "sub" tech forgot  to do his rinse back and so Otto's hemoglobein went from 12.4 to 7.9

[aharris2]

so today Otto comes home and tells me they gave him k3 instead of k2, is this bad? They said he'd be OK but HELLO this is the 2nd  in 3 months, a "sub" tech forgot  to do his rinse back and so Otto's hemoglobein went from 12.4 to 7.9

How the h*!! does a tech forget to rinse someone back??? I hope Otto is alerting the charge nurse to these errors, even if the tech/nurse is someone he likes. In a case like that, we just wait a couple of days and don't give specifics with the suggestion that the issue be presented to the whole staff. (Are we ignored? Who knows!)

There's a lot to getting a "dialysor" hooked up and running and in the in-center scenario each tech has a lot of "dialysors" they're caring for making it easy to miss something. I encourage everyone who can to be their own backup plan - check the arithmetic on fluid removal goal and the machine settings for UF profile, sodium profile and pump speed, pay attention to the alarms for BP and arterial and venous pressure to make sure the limits are reasonably set. Check the bath. Knowledge is power! My brother and I do this. Even so, we have sometimes missed errors, but we have also caught many errors and prevented my brother from suffering the consequences.

About the bath - they're pretty casual about it. In the past, my brother's was a 1K/3.5Ca bath. Then the unit simply changed to a 1K/2Ca bath without comment. While traveling we sometimes encounter a 2K/2Ca bath, also without comment. C'mon folks! Share! If the "dialysor" is aware of a change, that individual can act accordingly  - talk to the doctor, or adjust the diet/supplements to compensate. Is a 3K bath bad when the "dialysor" is prescribed a 2K bath? Absolutely! But since Otto knows about it, he can just be extra careful about his potassium intake for a couple of days. Again, knowledge is power!

Our unit recently changed to a 2K/2Ca bath for EVERYONE citing the concern for dangerously low potassium post treatment. After 8 1/2 years, there is a sudden concern for low potassium? Hmmm... Turns out that the neph can still override the policy under certain circumstances, so my brother is happily back on a 1K/2Ca bath.

[aharris2]

So, I'm stuck on 2K with a more restricted diet.
- No, you have other options to get in more dialysis so your diet can be more liberalized.  You have made the choice not to do so.

Next they will probably take away our phosphorus binders and say "you just have to eat less phosphorous"!!! - This comment is "Dumb is Dumb."   

Dumb is Dumb!!!!  

I see Rerun's post as a bit of venting over certain losses such as the loss of that little bit of dietary freedom (just a little bit of freedom, but so very important in the face of so many other restrictions.) And there you go again, PatDowns, engaging in a personal attack marginally dressed in the sheep's clothing of advice. Then you continue with the directed comeback "This comment is "Dumb is Dumb"" What did you mean to say? Are you spinning a personal attack, taking the edge off by quoting the original post but directing it at the writer, camouflaging it by noting that your comment is directed at the comment?

Rerun, I hear you loud and clear. In the face of everything that ESRD is, it sucks when a unilateral (and unnecessary) decision takes away a little bit more of what the individual was previously able to enjoy.

PatDowns, there was certain merit in ANDREW'S last suggestion here on IHD. 

[RichardMEL]

[moderator hat on]
I read Rerun's comment about Phos binders to be sarcastic myself, and not serious. The "dumb" comment was not really warranted in my view.
[/moderator hat off]

Just on the bath issues, noah's comments about the K ranges and the baths to be used generally agrees with what my unit down here would do. I was mostly on a K2 bath because my K usually hovered between 4 and 4.7ish, I went onto a K1 for a few months when my K went to 5.3-5.5, and that brought it down to around 4.6 - well above getting too low (but by the same token I probably did take a few liberties with my diet during that time  ). Certainly because K levels can bounce around quite quickly you don't want to be too agressive because it can go low, and that's just as bad as going too high (the eternal balancing act).

The thing that puzzles me is why nephrologists would say no to having a K1 bath available at all. I mean... huh? Actually in my unit the nephs has next to nothing to do with that that I noticed. The nurses doing the day to day care would select the bath based on the lab work. Oh, I'm sure a neph could order or suggest a change, but usually the nurses are the front line troops able to make changes in a more timely manner than waiting to see a neph to look at some weeks old labs to make a suggestion. At least every time a change was made with my bath they discussed it with me - but only really because all my nurses knew I was anal about my numbers and had some idea of the issues, so they could discuss it with me and know I'd understand what the deal was (most other patients could give a crap to be honest). Still, I'm surprised that removing access to a K1 bath would be a medical decision - it seems a bit short sighted because if K went up, and left untreated by going to a higher K pulling bath like a K1, which I would call the first line of defence, you'd be forced to more agressive and unpleasant forms to get  the K down, like the K binders, that awful mud stuff, or worse. I would sure as hell be asking questions as to *why* the bath was not available for use. I can understand it being perhaps not appropriate in some situations for whatever reason, but to not even have it available seems odd to me.

[paris]

Just a couple of reminders ---- Please take a moment to know something about the person you are commenting on.  If you don't know their history, you can't respect their comments.  Rude comments, remarks or putting someone down isn't a part of IHD.     Next, when anyone posts a quote, put your comment regarding the post after the quote -- not in the quote.  Simple things like this keep the forum orderly. That is why we have been around awhile.     

It doesn't take long to get to know another's story.  Everyone has a different experience and no one person could ever possibly know everything about kidney failure, dialysis and transplantation.  This is a very educated group.  Listen some times and you may learn too.    It is also rude to ridicule a moderator who devotes countless hours volunteering to keep this site alive and has been here from the beginning.   Just my 

paris, Moderator 

[sullidog]

Well a couple of years ago I took potassium out of my diet altogether, reason being I knew that too much could kill you, but at that time I didn't know too little could be trouble as well. My potassium was low and my team said I'm not going to do anything about it right now we'll wait til next labs, I started having heart palputations, informed staff, they said maybe your stressed, went and had an EKG, was funky, took my potassium, was 2.0! Had to take potassium via k lite, was soooo tastey, and potassium via IV, put me on a 3 k when I was on a 2 k. Right now k is 5.8 I asked if they are going to change anything, again got the answer we'll wait til next labs.

[lola]

so Otto went in today and AGAIN tey had K3 instead of K2 WTF!!!!! and they are suppose to be double checking, thank god Otto now knows to check

[ESRD Survivor]

Wow, only being a year on Hemo (spent 8 on pd) I never knew any of this.  How do you know which K product they are given you.  I can't wait till next year to train for home hemo.  No time this year for it.