Better to have loved and lost, then to have never loved

My provider the Northwest Kidney Centers (NKC) informed all of their PHD dialyzors that Aksys would no longer support the PHDs currently in use at NKC and those machines would be withdrawn from service by February 2nd. Bottom line for me is I have to reevaluate my options. I have a number of choices to make: Which machine? I can choose between the B Braun and the NxStage. Incenter or home? Hemo or PD for that matter; not to mention frequency and duration. After a relationship ends badly I think it is a good idea to reexamine habits and assumptions.

And that is how it feels - like a relationship ending before I am ready for it to end. I think tonight when I settle in with my PHD for 2 hours and 50 minutes of alone time, I will be getting the best dialysis minute for minute available. No other machine is offering the biocompatibility the Aksys offered or the other advantages of heat disinfecting and reusing the blood circuit. Advantages such as being able to use more robust materials for the blood circuit since the cost of the tubing could be spread across dozens of treatments. Ah, well. The point is moot.

And I can’t say it is a total surprise. All the news lately has been bad and while I like what I heard during my visit last month, the G2 sounded great but I know that it is a long way from the lab to my house. I hope that their patents and approach will live on under some recalibrated business model. However, there will always be new machines, new approaches; I am in this for the long haul and maybe four and half years will seem like about how long on average it takes for the ‘next thing’ to come along. What ever machine or modality it is it’ll come with new tradeoffs - clinical tradeoffs and logistical tradeoffs; tradeoffs between the clinical ideal and the logistical ideal, with the business calculus the measure of success.

Bill, I’ll be interested in hearing which way you decide to go. Is the Braun similiar to the Fresenius where you would have acid clean, heat disinfect and RO maintenance? My only thinking on running daily and short treatments is it would be alot of extra time out of the day/evening to maintain the machine and RO.


Just read on the renalweb board that Fresenius wasn’t selling anymore H machines after February 1st and they will only supply spare parts to the ones out there for 5 years. Guess your not going to be the only one deciding on what machine to go to.


Bill,Marty, this is really sad!
Does this all mean that Fresenius is having a downer too. Are we in for another monopoly type situation in the end, like what seems to be happening with so many corporations down under where there is no choice? Just big megastores taking over the little guys??
Enjoy your last days with you Aksys friend, Bill

There will probably be an M series machine coming out - but in five years you may be ready for the Baby K. I don’t have any info on what FMC is going to do but I think there are countervailing forces at work. On the one hand the large dialysis providers seem to be consolidating and vertically integrating – I would assume Davita is looking to buying a machine manufacturer – Gambro or Braun? Pushing against this consolidation we hear all sorts of rumors about wearable devices and such, so maybe new machines will be coming to market. And I still hope that someone will run with Aksys’s patents and bring the G2 to market under a new name - Aksys was not a good name, sounds to like access.

I have decided that I will begin using the NxStage with the PureFlow. If NKC gets new ROs I may switch to the Braun but for now NKC has to switch 16 people over and since I am up to speed on the NxStage it should be easy to check me out the PureFlow and send me on my way.

I have to say I am not happy about this switch. I am very spoiled being able to come home and get right on without stringing any line or snapping and tapping. More than the convenience it is clear I will need to run longer than what I have been doing on the PHD. There is no way to get the NxStage to provide my required dose in three hours without turning up Qb far beyond what I would allow.

I would like to try the NxStage, using 60 L of dialysate, a FF of 100 and Qb 300 but the current FF range is 40 to I think 25 which does not fit what I would prefer to run. So that leaves the alternative of dialyzing overnight at a FF of 40, Qb 250 – 300 and 30L of dialysate.

I am not sure I could be less enthusiastic. I’ve heard both Paul Allen’s and Bill Gates’ name mentioned in regard to the idea that we need someone to buy the company and carry on, it is hard to accept that the best dialysis will no longer be available. However my rule of thumb is once I hear “If only Gates would write a check” I know we are out of ideas.

Why would you not do the 60L nocturnly? Ralph is on that now with a FF or 35. We have a Bp speed of about 380 and he is doing really well.
I know you think it is a pain to snap tap etc but let me tell you from my perspective I can do every thing that needs to be done in 12 minutes and I am sitting there sometimes for 8 or 10 minutes waiting for the rinse back.
In that time I get every thing else done. The snap and Tap takes all of a minute and we are ready to attach.
WE love the Nxstage.

I know Pat that it probably sounds like I am whining; it is a case of the devil you know being better than the devil you don’t know. I acknowledge that in a year I might think the switch was for the best, that nightly nocturnal is a good fit. In my heart I am trying to be positive and open to success.

One reason I was not well rested when I did the five weeks of daily nocturnal on the PHD was because of the sounds the PHD makes, a seemingly random clicking and whirring that I was not able to get use to; I know that the System One is far, far quieter. I am hopeful that nocturnal will be a good fit.

As far as the dose and using 60L, or 50L (one bag a night) I’m not opposed but I just do not like the FF approach to setting the run parameters. I would like to hear a argument in favor of the FF approach but to me I would like it if I just set Qd directly, most importantly I would like to set Qd independent of Qb. For instance in your own case I would think it would be to the good if you could simply set Qd at 120 or 125 if that’s what you thought was best and then have the option to set Qb at what ever you’d like. Right now you are boxed in and would have to compromise dose to run at a Qb of 250.

What exactly is the point of FF other than to value the dialysate above the dialyzor’s time?

Bill, You aren’t a whinner. I know where you are coming from. Once your used to something and it is working well, you have to give up the comfort zone and create a new one. I have been thinking of trying NxStage along time and one of the things that kept me sitting on the fence was that you couldn’t adjust the settings individually. But now knowing I will have to change machines at some point, and I have to make a choice, I just can’t see not at least giving the NxStage a try and get away from all the cleaning etc. with the machines and RO.

I hope you get as used to nocturnal as we are. I think if you can, you won’t want to go back to daily again. It’s not just that the treatments are longer which is suppose to mean better it’s that you don’t even think about the fact your having a treatment. Pretty liberating to the mind.

I don’t know how long it would have taken me to get used to nocturnal if I hadn’t kind of been forced. The 1st RO’s were noisy and having even the Fresenius in the house at first I heard every little thing it did. But when I first got home not only did the noise drive me crazy but dad’s catheter was acting up. Alarms all night. This went on about a week. Took dad back to center and had the TPA put in. Came home and I was so totally exhausted its a wonder I could think. The TPA stopped the alarms, and when my head hit the pillow I was out. The next morning when I woke up, and realized the machine ran just fine without me trying to figure out every noise, I heard. I knew I had crossed the threshhold of sleeping during dialysis.