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  1. #1
    Join Date
    08-25-14
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    29

    Default Cycler to Manual -- Is This Correct?

    I have been on PD for a little over two months and recently had a workup for moving to manual exchanges so that I can make a few trips without lugging around a cycler (not to mention the supplies). My clinic tested me and said I would need three exchanges a day of 1500 each with a dwell time of about four hours each. I really don't like the idea of moving around all day with fluid in. At the end of this post is my current treatment on the cycler. The readings are from last night and they are quite typical. The fill volume with manual is about the same as on the cycler but the dwell time is almost four times as long. I don't get it. Can someone please explain?

    By the way, I make about 1600 cc of urine which for me is normal and it has been the same since I went on dialysis a year and a half ago. My clearance is about 2.7 with about 2.5 from residual function. The clinic's study indicated my peritoneal was low average. I'm not sure what that means.

    Your thoughts and comments would be greatly appreciated.

    Thanks.

    - Max

    FILL DWELL
    VOL TIME UF
    Drain Zero.........16
    1107 65 -320
    1107 59 -19
    1107 46 -181
    1107 37 747
    1107 27 298
    5535 234 525
    Last edited by maxwellsmart; August 13, 2015 at 07:17 AM.

  2. #2
    Join Date
    11-23-09
    Posts
    41

    Default Re: Cycler to Manual -- Is This Correct?

    Interesting situation. First, your clearances from your residual renal function are great! Whatever you are doing to preserve that function, keep doing it. I find it hard to believe that cycling each nite is only providing 0.2 (2.7 minus2.5, right?) I suspect the total is much higher. As for changing to CAPD while travelling, ask your doctor is you can use icodextrin each night for a long dwell. You could test it out before you travel. Icodextrin is a large molecule solution so creates slow, gentle fluid removal during an 8-10 dwell. And since you are a low transporter via the peritoneal membrane, if clearance is not good enough with only 1 icodextrin long night dwell, you could perhaps have one small, long dwell CAPD exchange (maybe even 1 liter) which you probabaly would not even notice. Do you have a day time dwell now with cyler at night? with the long day dwell of CAPD you may be able to drain after a few hours and do dry until night. Hope this helps. Judy

  3. #3
    Join Date
    08-25-14
    Posts
    29

    Default Re: Cycler to Manual -- Is This Correct?

    Oooops!! My bad. I gave you incorrect info on my clearances. My residual = 1.78, PD = .75 for a total Kt/V of 2.53. That was my first full lab (w/24 hr urine) at the end of June since going on PD around the first of June. I have labs again this Thursday and will have new results back by next Monday.

    Based on your previous comment, the .75 for PD seems low, don't you think? I posted my cycler times in a previous post.

    Thanks much for your comments.

    - Max

  4. #4
    Join Date
    11-23-09
    Posts
    41

    Default Re: Cycler to Manual -- Is This Correct?

    Quote Originally Posted by maxwellsmart View Post
    Oooops!! My bad. I gave you incorrect info on my clearances. My residual = 1.78, PD = .75 for a total Kt/V of 2.53. That was my first full lab (w/24 hr urine) at the end of June since going on PD around the first of June. I have labs again this Thursday and will have new results back by next Monday.

    Based on your previous comment, the .75 for PD seems low, don't you think? I posted my cycler times in a previous post.

    Thanks much for your comments.

    - Max
    Those clearances make much more sense! Part of the reason for the lower clearance for pd is that you said you are a slow transporter, so to increase PD clearance, the prescription would need to change to a shorter number of exchanges with longer dwells. By the way, if Icodextrin is available, it works very well regardless of membrane transport, slow or rapid. Your residual function is so good that the Icodextrin overnite may be all you need while traveling.
    Judy

  5. #5
    Join Date
    08-25-14
    Posts
    29

    Default Re: Cycler to Manual -- Is This Correct?

    I'm not sure I fully understand your last comment, "may be all you need while traveling." Are you saying that I could spend the same amount of time with CAPD by using Icodextrin? Perhaps a two hour single exchange in the AM and two in the evening and dry in between by using the drug?

    Also, it seems I really don't need much in the way of cleaning due to my residual function since a) I'm not getting much now on the cycler (.75 Kt/V) and 2) While I think the local clinic has a target of 2 Kt/V everything I've read says that around 1.7 to 1.8 is sufficient. Heck, I have that now with residual. Am I looking at that incorrectly?

    Your thoughts?

    Thanks.

  6. #6
    Join Date
    11-23-09
    Posts
    41

    Default Re: Cycler to Manual -- Is This Correct?

    Quote Originally Posted by maxwellsmart View Post
    I'm not sure I fully understand your last comment, "may be all you need while traveling." Are you saying that I could spend the same amount of time with CAPD by using Icodextrin? Perhaps a two hour single exchange in the AM and two in the evening and dry in between by using the drug?

    Also, it seems I really don't need much in the way of cleaning due to my residual function since a) I'm not getting much now on the cycler (.75 Kt/V) and 2) While I think the local clinic has a target of 2 Kt/V everything I've read says that around 1.7 to 1.8 is sufficient. Heck, I have that now with residual. Am I looking at that incorrectly?

    Your thoughts?

    Thanks.
    Sorry if my last note was confusing. Icodextrin is ONLY used for long dwell of 8 hours or more. And only 1 exchange per day of Icodextrin. I do not want to presume to write your PD prescription. Just sugggesting you talk with your nephologist about using Icodextrin as a long overnight dwell when travelling. And, depending on the UF and clearances you get with that plus your residual renal function clearances, perhaps a long CAPD exchange in the day might be needed. You are right about the clearance targets, but remember those are numbers. The real measure of the quantity and quality of your dialysis is how you feel clinically. Are you well, active, eating normally, able to do what you like to do with your life? So of course this is where your PD nurse and doctor really can help you evaluate your prescription. Best of luck.
    Judy

  7. #7
    Join Date
    08-25-14
    Posts
    29

    Default Re: Cycler to Manual -- Is This Correct?

    Quote Originally Posted by jbernardini View Post
    Sorry if my last note was confusing. Icodextrin is ONLY used for long dwell of 8 hours or more. And only 1 exchange per day of Icodextrin. I do not want to presume to write your PD prescription. Just sugggesting you talk with your nephologist about using Icodextrin as a long overnight dwell when travelling. And, depending on the UF and clearances you get with that plus your residual renal function clearances, perhaps a long CAPD exchange in the day might be needed. You are right about the clearance targets, but remember those are numbers. The real measure of the quantity and quality of your dialysis is how you feel clinically. Are you well, active, eating normally, able to do what you like to do with your life? So of course this is where your PD nurse and doctor really can help you evaluate your prescription. Best of luck.
    Judy
    Okay, I understand. What I want to achieve is NOT to have a fill throughout the day when I travel and NOT to have to take the machine. Actually, where I was going with the comment about clearance is that at 1.78 residual I believe that I am borderline for dialysis. My numbers have changed since moving to PD. I run about 6 or so with creatinine and 50 or so BUN. They were lower with hemo. All of my other labs look fine -- especially potassium and phosphorus. They did not seem to change much with the move.

    You mentioned how I feel as being important. I feel great. I am active (on my own business and work 50 or 60 hours/wk) and walk about 20 to 30 miles a week. I was a runner for 30+ years but the sickness (lymphoma) that took out my kidneys also zapped my strength for running. I hope to start again, though. The bottom line is I feel great and have no other maladies other than being in remission from lymphoma and having kidneys that do not work so well.

    I have only skipped one treatment on PD since beginning and could not tell a difference in how I felt. When I was in-clinic I skipped two treatments in 18 months. Both were on a Friday which meant that there was no dialysis from Wed until Monday. I felt fine and could not tell any difference. Keep in mind I am not dealing with fluid since I make a normal amount of urine (1600 ml).

    Finally, I am in no way looking for a re-write of my prescription from you -- just your informed thoughts which I greatly appreciate. It's good to talk to my doc and nurse from an informed point of view. I would never make any change without the direction of my doctor. Now, I might get a second opinion, but whatever I do will come from the doc.

    Thanks much.

  8. #8
    Join Date
    08-25-14
    Posts
    29

    Default Re: Cycler to Manual -- Is This Correct?

    I have one more question. With someone who makes urine what do you typically see as far as PD clearance? .75 as noted below seems on the low side to me. As mentioned, we just ran the PD performance test (not labs) and I was rated as low. I'm not sure what that means in terms of numbers. Actually, I'm not sure what it means for my dialysis. My nurse indicated that for CAPD I would need 3 1500 fills per 24 hour period with dwells in between (no dry time) in reading the study. Well, what does that say about PD on the cycler? She did not change my cycler prescription.

    Thanks.

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