Filter Size

[Simon Dog]

I'm new to HD (PD proved inadequate for me  ) and on a catheter until I can get the fistula done (soon).   I'm a Fresenius patient, and always have been running with the yellow light on since I was coming up a bit short on the target Kt/v of 1.4 (generally hovering around 1.25 or so), which the tech and RNs always told me was because it's harder to get good flow with a cath than a fistula.   I asked my doc about trying the 180 filter (the series I use comes in 4 sizes - 160/180/200/250) and he agreed.  Solid green on the next run, Kt/v of 1.46.  Yeah!!!

I asked what kind of grief my doc would get for using the more expensive filter on me, and was told that a 180 is no problem but a 200 would require approval from the corporate pharmacy & therapy committee, and that these are approved only in case of medical necessity (they won't let you have a 200 just to get better Kt/v unless you are not meeting goals).  I guess that means a 250 is about as right out as counting to 5 when pulling the pin on the Holy Hand Grenade of Antioch.

The real lesson is stay informed - nobody offered me the 180; my neph (who is probably the best doc I have ever had) never mentioned filter sizes; and if it weren't for the mention of 200's in Bill Peckham's blog, I would have never known to google and find http://fmcna-dialyzers.com/optiflux.html. Federal dialysis felons at the federal prison in Devans, MA get the good stuff - it's only the best for them - no problem getting a 200 if you are in the big house.

[Zach]

Wish I could get on the Optiflux 250, too!!
Much better beta-2 microglobulin (B2M) clearances.

[Simon Dog]

I've been advised there is no way the P&T at Fresenius would approve a 200 for a patient making corporate goal (Kt/V 1.4) on a 180, which means a 250 is right out.

Medicare guidelines (which set private care standards to an extent) are clear - patients are entitled to "adequate" treatment, not "the best treatment possible" .... even if "adequate" means greater mortality risk.

We all need to be our own best advocates since nobody else has signed up for that job