[Allient Sorbent] New Website Launched

Interesting point. However, it’s really just speculation unless someone does a study on it. In my own experience, 2 hour short daily which I did for 3 months with just a conventional machine reduced my phosphorus to almost normal levels. As someone with technical expertise posted before on here, some backflushing is occurring all the time in dialyzers. We just don’t know it’s happening because it’s not actually programmed like in the Aksys, so, the end effect may be the same.
Pierre

A question for Bill Peckham- when you do nocturnal txs with the Aksys, do you use the flushing mechanisim?

The flushing technique is not widely known as most patients don’t get individualized txs. I have known of two patients who performed flushing manually. Both were long term patients. I saw the labs of one of the patients, and in most respects, she had the labs of someone doing nocturnal dialysis yet she dailyzed 3x a week for about 4 3/4 hours. She did not require EPO.

I think these discussions are confusing in the fact that we never know if we are comparing apples to apples or apples to oranges. I do believe more dialysis is better but I wonder what impact the Blood Pump Speed, the flow rate etc. has on the treatment. Someone running 2hrs a day at a blood pump speed of 250 is the dialysis better than someone running 3x a week 4 hrs with a pump speed of 350. How much backflushing does it take to actually get more benefit out of a treatment? I think the everyday is better in that it eliminates the highs and lows and keeps things more consistant. But just a theory I have no knowledge what so ever to make this a medical judgement.

I have gone to the Allient Sorbent website, but found the info there rather vague. Does anyone have more expansive info on how this machine compares with the competitors for home programs?

I finally got around to checking out the Alliant web site. From what I read it sounds like the Alliant is geared to provide 3 treatments a week. At least the clinical study that is proposed is a three day a week regime (from http://www.renalsolutionsinc.com/home/training_whitepapers.html):

“Twenty-five chronic hemodialysis patients will be included in this study. Patients will be trained and transitioned in a dialysis clinic setting for 8 weeks to longer, slow 6-8 hour treatments 3 times a week. After training, the patients and their individual care giver will self administer dialysis in the home for another 8 weeks.“

The thing I am excited about is that I hope this machine will fill the role that the Redy machine filled. I hope this machine becomes available for holiday use by patients that dialyze at home. When I travel I have to switch to a three day a week schedule; I would prefer to switch to a three day a week schedule using a transportable machine as opposed to setting up treatments in a center.

Does anyone know where they are doing the trial?

As far as the backflush process on the Aksys: Yes. When I did the nocturnal study on PHD the machine backflushed every 15 minutes. I understand the backflush a bit differently than estonb. The backflush can increase convection because convection results when the UFR is, I think, above 1kg/hour. Convection in turn can increase middle molecule clearance but there are some variables to consider. I think the backflush is helpful (it is optional – you can run the PHD without the backflush. I choose to have a backflush every 15 minutes) but I agree with Pierre that until a study looks at the impact of the backflush we can’t really say what is going on with the middle molecules…

That was me - I guess I was logged off while I wrote my post in Word.

Bill

Aha, so it was you! :roll:

The studies on the Allient Sorbent is taking place back in East, prolly close to you…read this page http://www.renalsolutionsinc.com/home/training_whitepapers.html

They say to contact your clinic or Dr. …I have done the same, but their not ready for the Allient…

Gus you’d switch to three times a week to use the alliant?

I wonder if the 3 times a week isn’t just for training.

I probably would but doing 7-8 hours every two days…it’s capable of daily-short and Nocturnal but this Allient machine is not quite portable…its bigger than the NxStage System One. On the other hand, Aksys is making a new portable version of their PHD that can do both daily-short and Nocturnal…there are some nifty designs coming our way and I think you’d might like the new designs more than Allient… :roll:

I think the Allient is just portable. I thought I read where it had a weight of 110 pounds.

Nice article in this month Nephrology News & Issues on the Allient Machine.

Did it convince you? Did it make you feel confident enough to try out?

Gus, There is only 1 question I have left before I would try it out and that is how they are going to handle service calls. If they handle it like NxStage and ship you a new one…it’s a go for me.

History:
Article has the following comments: Introduced in 1973 sorbent dialysis uses a column of specialized chemicals - the sorbent cartridge to regenerate used dialysate back to the dialyzer. This cycle is repeated throughout dialysis as a result only 6L of dialysate, made from ordinary drinking water is needed for an entire treatment. Thus the entire sorgent dialysis apparatus - blood and dialysate circuits, water treatment system (another function of the sorbent cartridge) monitors and safety systems can be packaged into a single unit. The resulting REDY system was widely used for acute dialysis, due to its portability and treatment flexibility. It was also used in water quality or quantity shortage areas such as Australia, Saudi Arabia and Kuwait and by the military services which may need to perform acute treatments under battlefield conditions to stablize wounded servicemen prior to evacuation to military hospitals. It was also handy for vacation dialysis at summer camps, in motor homes or on crusie ships. Then in late 1992 a competitor purchased the company and promptly discontinued the REDY machine production. Later the technology was sold to a private company which continued to provide the sorbent cartridges and dialysate chemicals…

Now in the early years of the third millennium the value of more frequent and especially longer duration dialysis is being increasingly recognized within the United States. That trend, along with the significant increase in ESRD patient population projected for the year 2010 and the worsening shortage of doctors and nurses has recently led to an increasing interest in home and self-care hemodialysis. Sorbent technology originally developed for home hemodialysis and introduced just as that modality began to decline in the United States has evolved as well.

CARTRIDGE UPDATES
The sorbent cartridge has been significantly redesigned and reformulated to bring a number of improvements in function and application. There are four significant changes and retention of one significant, but initially, under appreciated function.

“Treatment times” - Times change – literally. Patients are now being offered treatment options that include long slow dialysis as well as short rapid treatments. Sorbent cartridges have changed as well. There are now two lines of cartridges one line for short treatment times (3 to 5 hrs) and one line for long (up to 8 hrs.) dialysis.

“More coverage”- The new cartridges are larger and contain more sorbents, resulting in greater urea, creatine, and phosphate capacity. This is particularly useful because today’s patients - like the general population tend to be larger as well.

“Better dialysate flow” - In the past the dialysate flow rate in sorbent systems was limited to 250mL/min because faster dialysate flows were very likely to cause channels to open within the chemical layers, enabling dialysate to flow through the cartridge without adequate regeneration. Today due to significant improvements in internal cartridge design, the new short treatment Sorb + cartridge line can accommodate dialysate flow rates up to 400 mL/min a 60% improvement over dialyste flow rates with older models.

“Better solutions” - There are significantly improved sodium, bicarbonate, and Ph dynamics. The new cartridges generate additonal sodium bicarbonate, since both the cationic and anionic exchangers (zirconium phosphate plus the new hydrated zirconium oxide layer), now release sodium bicarbonate into the cartridge effluent.

“Infection control” - There is another function of sorbent cartridges that often went unnoticed in the past, but is receiving new attention today. Sorbent cartridges are excellent bacteria and endotoxin filters. Although the dialysate is not pefectly sterile, its repeated passage through teh cartridge results in maintenance of dialysate levels of bacteria and endotoxin below 1 CFU/mL and 0.5 EU/mL respectively.

PATIENT SAFETY Beyond the significant improvements in cartridge function and system design for the new millennium, the fundamental advantage of sorbent regenerative technology remains intact: it is inherently safer for the patient than single-pass dialysis systems.

Sorbent dialysis uses only 6L of dialysate for an entire treatment. Ther is no water treatment system (the sorbent cartridge serves that function) no water inlet lines, and no drain hose to leak and present tripping or sliding hazards to busy staff members or home patients.

The used dialysate is regenerated by passage through the sorbent cartridge, then stored in a reservoir and returned to the dialyzer. Even the patient’s untrafiltrate, present in the used dialysate leaving the dialyzer, is converted into dialysate by the sorbent cartridge. As the initial 6L dialysate volume expands due to addition of regenerated ultrafiltrate, the volumn (thus weight) of the reservoir increases. The increases in reservoir weight are continuously measured and displayed. This method provides the precision of direct UF measurement without depending on the accuracy of the dialysate or UF pump calibrations. This increase is displayed throughtout dialysis so the patients UF status is always precisely known, which is particularly useful in acute treatments, where inadvertent under or over ultrafiltration can cause significant complications.

TECHINICAL ASPECTS
In the closed system of sorbent dialysis, except for those solutes removed by the sorbent cartridge (mainly uremic wastes) or added to dialysate via the infusate system (prescribed amounts of calcium, potassium and magnesium acetates), the patients body fluid composition by virtue of its much larger volume, controls the chemical compostion of the dialysate. In the rare instances where human and machine safety procedures fail, and the patient is exposed to a significantly abnormal dialysate (i.e. one concentrate is missing, meaning dialysate sodium is perhaps half of that prescribed) the risk to the patient on a sorbent system is signifcantly reduced. The patient will donate some sodium from each liter of body fluid to the dialysate. For example, assume an adult patient is donating 4-5meq for 40L of body fluid or = 180 mEq of Na into the 6L of dialysate. Such a patient would raise dialysate sodium by 30mEqL. That contribution, plus a small donation from the sorbent cartridge, causes the dialysate sodium, chloride, bicarbonate and other levels to rise to safe values within a few minutes. As a result dialysis can continue. The outcome would likely be different if this sort of accident happened with a single pass dialysis system. Finally as mentioned earlier there is no internal dialysate pathway to disinfect. As a result there is no possiblity of patient exposure to residual disinfectant or decalcification chemicals.

SUMMARY
Thus, in a variety of ways, the unusual relationshop between the patient and machine in sorbent dialysis reduces the risks thate are inherent with single pass systems. This pays dividends for both patients and professionals. Given the growning need for home and self-care dialysis in the new millennium, the time is right for the introduction of an updated, revitalized sorbent dialysis system.

Pulsar blood Movement System The Pulsar Blood Movement System a bood pump apparatus that can accommodate both single and dual lumen vascular access without requiring a specialized blood set for each mode or a mechanical adjustment to change pump configuration. The desired mode is simply programmed into the system via touch screen control prior to dialysis. This provides treatment flexibility, which is especially useful in acute dialysis where vascular access is highly variable.

There are additional unique elements contained in the blood pathway as well. For example there are bubble detetors but no drip chambers, thus reducing the risk of in advertent air embolism and possible coagulation at the air-blood interface. Ultrasonic flow detectors on both blood inflow and outflow lines continuously provide direct measurement of the blood flow rate.

This is pretty much the article. I haven’t proof read this so if you read it and want me to check something that you think maybe wrong let me know.[/u][/b]

Very interesting indeed, but hey it couldn’t be that hard to find out whether they will offer support services like NxStage, just send them an email message or maybe calling them. If they don’t, that would be an awful drawback for both clinic and patient…

Gus, I e-mailed them let you know if I get a reply.

Hey, that’s great! Now the drum rolls… :roll:

Got a call today from the Allient Sorbent people. They are going to do acute trials first. They won’t be starting trials for home patients before March. Service they are looking at having their own reps and possibly some 3rd parties. Nothing definitive. Projections only. They are going to call me every 3 months with updates on where they are at and what they are doing. Keep you posted if your interested.

Oh okay I see, they’re still in their IDE study…

Hmmm, time will tell then until they make their final directions…

Certainly, keep us updated one this…alot of us here who visit are interested…

Thanks for informing us about this…