graft and home hemo

[happyonhemo]

I'm on home hemo(NxStage) and my fistula clotted recently while in the hospital(another story!) and now obviously I have a catheter until something else can be done.They tried to de-clot my fistula and it didn't work so now we have to try something else.Here's the thing-my fistula was in my left upper arm as the lower arm had my first fistula which lasted 17 yrs.until a tech taped it too tight and it clotted.(I blame myself-I should have known).My right arm most likely won't be able to support a fistula due to so many years of IV's also prednisone causing my skin and veins to be thin and fragile. So my options seem limited-either a fistula in my upper leg or putting in a graft-and I'm not thrilled about either.I'm wondering if a graft can handle daily dialysis and if so-how long could it last?I would appreciate any input on my situation.Thanx.

[greg10]

Welcome to the forum, and I am sorry to hear about your fistula.

Unfortunately, there are not too many choices and none of them as good as a fistula.  There are advances in graft material such as the new Gore Acuseal, but their long term patency is unknown.
http://ihatedialysis.com/forum/index.php?topic=23416.0

Statistically 50% or more of implanted graft failed after 1 year, 80% or more in 3 years.

I'm on home hemo(NxStage) and my fistula clotted recently while in the hospital(another story!) and now obviously I have a catheter until something else can be done.They tried to de-clot my fistula and it didn't work so now we have to try something else.Here's the thing-my fistula was in my left upper arm as the lower arm had my first fistula which lasted 17 yrs.until a tech taped it too tight and it clotted.(I blame myself-I should have known).My right arm most likely won't be able to support a fistula due to so many years of IV's also prednisone causing my skin and veins to be thin and fragile. So my options seem limited-either a fistula in my upper leg or putting in a graft-and I'm not thrilled about either.I'm wondering if a graft can handle daily dialysis and if so-how long could it last?I would appreciate any input on my situation.Thanx.

[noahvale]

^

[jbeany]

My graft lasted for the nearly 3 years I was on D.  Kit had one that made it 8 years, I believe.  Mine was very prone to stenosis, though - I was a regular visitor to the doc in charge of ballooning and stenting.  Every 3 months was about my average.  Still, it kept chugging along until the week after my transplant.  I was due to have it ballooned the day I had my transplant, and the transplant docs ignored my requests to get the ballooning done before it clotted off.  (And then I had complications and was too doped up to continue to argue!)

I used mine on NxStage - I actually needed it ballooned less frequently with 5 times a week at home.

[PatDowns]

I've had my AV graft for 5+ years with stenosis being the main complication.  Like Noahvale, I'm still on Plavix and 81 mg. aspirin.  When looking into NxStage, the first concern that came to my mind was the toll of daily sticks on the graft.  My vascular surgeon discouraged it based on my access history and his own patient population outcomes.  However, see what your VS has to say.

[happyonhemo]

WOW!You guys have all given me a lot to consider.This is exactly the kind of input I was hoping for.I still don't know what I'll do but now at least I won't be going in blind when I see the surgeon next week.As for nocturnal,I guess thats something to think about.I was on nocturnal before going to daily with NxStage and I loved it but switched for a few reasons.One was that the hours were really hard on my husband who drove me.It was 8pm to 4am and it was a half hour drive each way so he had to get up at 3:15am to leave at 3:30 to pick me up at 4:00 and he couldn't go back to sleep so he was pretty much garbage for the rest of that day and that affected everyone.Also,all these years of dialysis have caused very painful beta 2m amyloidosis and the neph told me the best thing for that next to a transplant was daily dialysis.Does anyone know where I can find some statistics on different modalities?At this point I'm even considering PD so I need to arm myself with as much info as possible.Thanx again and thanx in advance for any more input.

[noahvale]

^

 

[tyefly]

To add  about nocturnal  or Extended as they like to call it.....   you can do one day on and one day off so that you will not be doing it every day but 3 days one week and 4 days the next..... and if you do 7 to 8 hours on those days... you will have alot more dialysis with the same amount of days as incenter.... or incenter nocturnal...     I would think about this option as well..... 

[sullidog]

Mine is also prone to stenosis and has it again, I also had calcium buildup in it wich didn't shut it down but made it hard to canulate.
That's interesting that you mention the 16 gage needles are better for it because my neph likes to crank my graft as hi as it will go and he gets mad when it can't achieve 450.

[PatDowns]

Mine is also prone to stenosis and has it again, I also had calcium buildup in it wich didn't shut it down but made it hard to canulate.
That's interesting that you mention the 16 gage needles are better for it because my neph likes to crank my graft as hi as it will go and he gets mad when it can't achieve 450.

It is so frustrating to read about patients running at such high blood flow rates.  The phenomenon of cranking up the pump is directly attributable to dialysis centers wanting to get high patient chair turn around in as short of a period as possible to maximize profits - not quality of care.   Many renowned nephrologists are adamant in their belief that short treatments - made possible by raising the pump speed - leads to poorer dialysis, increased medical complications and poorer survival rates.


While there are no definitive studies proving so, there is more than anecdotal evidence showing that high blood pump speeds ( >350 ) resulting in high AV flows, can put stress on and damage accesses as well as cause left ventricular hypertrophy of the heart.   Plus, greater turbulence from high pump speeds can lead to more recirculation in the access, therefore, poorer treatment.

However, there are definitive studies showing that longer time dialysis, as opposed to higher pump speeds just to get more blood through the dialyzer, leads to better phosphorous and other mid-level solute clearances, better BP control and less dialysis fatigue symptoms.  The nephrology group that I use believes that an adequate compromise, given provider constraints of incenter dialysis, should be a minimum run time of 4-4.5 hours with a maximum blood pump speed of 350-375.  Granted, this also puts more responsibility on patients to be compliant with dietary and fluid restrictions.

[tyefly]

Well stated Patdowns.... why does this keep happening.....  we keep hearing this over and over....  I am now doing nocturnal or extended....Nxstage.... I  am the first to do this at my clinic.... I have been doing this for a few months now and loving every sleeping minute... I ask the nurses at the clinic a few days ago if anyone else doing extended Nxstage..... there reply was ..." we have one person that is interested but we havnt decided if we are going to let him do it.,"    IT took me 8 months to convince them.... I hate the fact that these people in center and at these clinic feel like they can control everything... and talk down to you and you have to beg just to get better dialysis.... I will be glad when I am transplanted and done with the whole thing.... I hate to have my life in the hands of others and their opinions...

[kitkatz]

My graft lasted ten years, but I was on three days a week Dialysis. I would think a graft would not last long given daily dialysis.