Howdy, I am a 2+ year Nxstage user. At present, I treat 6 days/week, but have been thinking about going to 7 days/week. When I talked to the folks at my center, they indicated that there would be no reimbursement for the 7th day. Anyone else had a similar experience? Anyone treating 7 days?
Thank you.
Not only do they not pay for the 7th treatment, Medicare does not pay for treatments 4, 5, or 6. They will only cover 3 treatments per week. One reason why clencis/Nephs dont push for NxStage more. Its all about the numbers for most clenics instead of what is best for the patient…
Hi Pabblo,
Unregistered is right about what Medicare will routinely pay for*. Some private insurance will pay for more days, although this is by no means a sure thing. If you’d like more dialysis than you are getting with 6 days a week, you might see if you could either switch entirely to nocturnal (this can be done with the NxStage machine and an add-on heparin pump) or do 2-3 nights/week and alternate with days.
*With a letter of medical justification from a doctor, Medicare may pay for a 4th treatment–which enables many clinics to provide a 5th & 6th (but not a 7th)
Dori
[QUOTE=Dori Schatell;16568]Hi Pabblo,
Unregistered is right about what Medicare will pay for. Some private insurance will pay for more days, although this is by no means a sure thing. If you’d like more dialysis than you are getting with 6 days a week, you might see if you could either switch entirely to nocturnal (this can be done with the NxStage machine and an add-on heparin pump) or do 2-3 nights/week and alternate with days.
Dori[/QUOTE]
I also asked about doing a tx on the 7th day and was told no go- we don’t get paid. I feel so well 6x that now the 7th day is very uncomfortable. I call it my “bad day”. Instead of a day off, it is actually a day to feel unwell and all I think about is can’t wait for the next tx. I feel I would really benefit from a 7th tx- I am thankful to feel well 6x, but it is sort of a painful reminder of how much I suffered before when I was on 3x dialysis, an experience that I would like to forget.
Whether more dialysis would help as far as doing nocturnal, Dori, I don’t know. And I doubt doing 2-3 nights alternating with days would help either. Because whereas toxin build up is one thing, the other problem is fluid build up. I believe what makes me feel so well 6x is getting the fluid off, toxins too, but fluid is what affects me so much. It is great to go to sleep at night, just having done my tx, with all fluid removed. That’s why I always do my txs after supper. I can have a last drink while on the tx.( and my post weight reflects it was removed), but I never eat or drink post tx. until the following morning at breakfast. This might also explain why I sleep so well at night since starting 6x txs.
When you do nocturnal, though, you don’t just pull off the fluid that happens to be in your bloodstream at the time of the treatment, you ALSO pull out fluid from inside and between the cells through a sort of “waterfall” effect (called capillary refill, if you recall Dr. Agar’s talk).
So, if you were to do an 8-hour treatment on a Saturday night, I suspect that you would still feel very well on Sunday, even without a short treatment, until you could dialyze again on Monday. Perhaps folks who do nocturnal could weigh in on this…
The good news is that you have 6 good days a week instead of 3 or 4, which is still a net gain. I agree that in a perfect world, you would be able to dialyze 7 days a week. The wearable artificial kidney may permit this when it comes on the market. It’s just common sense to replace end-organ failure with replacement therapy that mimics the human body as closely as possible.
[QUOTE=Dori Schatell;16571]When you do nocturnal, though, you don’t just pull off the fluid that happens to be in your bloodstream at the time of the treatment, you ALSO pull out fluid from inside and between the cells through a sort of “waterfall” effect (called capillary refill, if you recall Dr. Agar’s talk).
So, if you were to do an 8-hour treatment on a Saturday night, I suspect that you would still feel very well on Sunday, even without a short treatment, until you could dialyze again on Monday. Perhaps folks who do nocturnal could weigh in on this…
[/QUOTE]
This is precisely what I asked Prof. Agar. At his web seminar, someone asked him the same question and I was surprised to hear him say that nocturnal does not get off that much more fluid. It may be that I misunderstood his answer, but that’s what I thought I heard him say. I will be starting nocturnal soon so I will know firsthand if it makes the 6 days more comfortable and the day off more bearable. I hope very much this is the case due to capillary refill. There are so few nocturnal patients who post on the boards. Usually their caregivers post for them. I, too, would like some reports straight from the horse’s mouth, the nocturnal patients, themselves, re if they get this bonus of extra fluid removal, thus allowing them to feel better. I may put in a call to one of the nocturnal programs to see if there is anyone who can clearly answer this question. I have wondered about it for a long time.
I am on 6 nights a week nocturnal - atleast 7 hours each night unless I have time for some more.
I am on a Fresenius 4008 S. The amount of fluid I remove each night is decided by me after I weigh myself prior to starting treatment. For example, if I have put on 3 kgs after I got off my last treatment that morning, I usually set the UF goal to 3.5 kgs because I have 500 ml of water during the treatment.
I can comfortably remove fluid at the rate of about 600 ml per hour. When I need to remove more, I use a UF profiler which pulls off more fluid in the beginning and less towards the later part of dialysis.
I am not sure how the NxStage machine works since it is not available in India 
but maybe the way the UF works is different from the Fresenius ones.
-Kamal
Hi Kamal,
Did you start off doing dialysis with nocturnal txs or did you do short txs to begin? I am always interested to hear how much improvement others experience when they switch from short txs to nocturnal re fluid removal, but also when it comes to other benefits of the tx.
A professional told me that the most fluid one should carry in ones body is 2.0 weekdays and 3.0 through the day off. More than that is supposed to be a detriment to the heart. This applies to all on dialysis irregardless of size. I don’t know if this is an accurate statement, but just sharing what was explained to me.
It is possible to do UF profiling on NxStage, but it must be done manually by changing the input numbers when ready. Wouldn’t work with a nocturnal tx unless one woke up from sleep to change the rate.
I started off doing short daily. I did that for about 4 months and then switched to nocturnal.
I feel much better post treatment on nocturnal than I did with short daily. The problem with short daily was the fluid removal is still at a high rate and the pump speed is also fairly high to get good clearances. So,there was considerable fatigue after a treatment.
The sleep was better on short daily than on nocturnal. But its not that difficult to sleep on nocturnal. I do wake up a few times. Nothing bad enough for me to go back to short daily.
Kamal
With noctunal, the issue isn’t taking off more fluid, but taking it off at a slower rate. The other issue is allowing more solutes, especially middle and larger molecules to get removed.