Comparison of NxStage vs AKSYS

Discussions for Patients, Family, and Friends HD For Patients
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Cathy writes:
conductivity is a result of the mix of the chemicals and will change depending on sodium, potassium, bicarb etc. The machine can get out of whack and not mix everything completely properly which will affect the conductivity.

Jane- I agree. I understand the machine is calibrated internally for conductivity. What this setting is I don’t know. Depending on the chemical mixture, which is affected by the bicarb mixture for that day which is mixed by a tech in a large vat for the entire unit, this is what will determine the rate of conductivity for the tx. Because my conductivity, before sodium modeling is engaged, is usually about 13.9 to 14.1 ( depending on how tech has mixed), I use a base sodium of 142 and sodium modeling linear 148 for the entire length of my tx to increase the level of conductivity and keep it from sinking too low by the end of tx. This prevents crampiness that occurs with too low a conductivity.

This is one setting I found that works for me. There could be others, but I don’t know enough about sodium modeling and UF settings to know how to customize further.

Cathy writes:
On my machine, the Fresenius, on the dialysate screen there is an ideal conductivity based on the mixture shown. Mine with a 142 sodium and 40 bicarb and 3K general bath, should be 13.9 but runs at 14.1 which I like. I felt awful with a conductivity of 13.3 so am very careful never to run that low again.

Jane- don’t know what you mean by “ideal conductivity” unless you just simply mean the screen is showing the conductivity based on the mixture for the tx. Also, staff measures conductivity and pH with a handheld meter prior to tx and ususally the true reading differs by about .2. Do you use a hand held meter at home?

I was put on another machine in the unit once that had a conductivity of about 13.4 and I experienced the same thing as you - felt like my electrolytes were totally out of wack and made me very sick. Read where someone said a low conductivity means patient is deprived of sodium.

Cathy writes:
It is possible that the machine she is running on needs to be recalibrated to get the conductivity up. I have no adverse affects from running at a 142 sodium and my blood sodium is always near the low side and I am not thirsty all the time.

Jane- I can handle a 142 sodium too, although I feel even better with a 140 sodium. But to run a 140 sodium I have to have an initial conductivity of 14.3., and then also, I do not need sodium modeling, just a straight 140 sodium.

I have figured out what settings work for me by trial and error, and as I said, there could be even better settings. Did you get any training in this or did you figure out on your own also?

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Jane- don’t know what you mean by “ideal conductivity” unless you just simply mean the screen is showing the conductivity based on the mixture for the tx. Also, staff measures conductivity and pH with a handheld meter prior to tx and ususally the true reading differs by about .2. Do you use a hand held meter at home?

On the dialysate screen on the Fresenius machine, the top number on the left is the ideal conductivity, it is what you “should” be getting considering the mix of chemicals. Mine is often off by .2. Yes, I also have the hand held meter to double check the conductivity, it is also generally within .2 which is good enough for me.

Jane- I can handle a 142 sodium too, although I feel even better with a 140 sodium. But to run a 140 sodium I have to have an initial conductivity of 14.3., and then also, I do not need sodium modeling, just a straight 140 sodium.

Are you saying your conductivity varies alot without the modeling?? I don’t find that mine varies more than .1-.2 during the entire treatment. I don’t think it should really change much, especially in center, when you aren’t dealing with a bit of settling of the bicarb.

I have figured out what settings work for me by trial and error, and as I said, there could be even better settings. Did you get any training in this or did you figure out on your own also?

You get training in that you understand what is going on. I make no changes without permission, although my permission is that I can decide what sodium (between 140 and 142 to run at), I can play with my bicarb although am running constant at 40 right now to see if I can get my CO2 up to a decent level, I can choose my U/F profile etc. I’ve never tried Sodium modelling and might ask about experimenting with that too, but right now I’m not having any dialysis issues so think it probably best not to risk it.

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I administer EPO myself…but not through I.V. …I also need iron but that’s administered in clinic once a month…I don’t use heparin, and I do use supplements like Nepro, Enlive, and Procel…as for vitamin D I only take Ulta Tums!! … 8)

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Gus writes:
administer EPO myself…but not through I.V. …I also need iron but that’s administered in clinic once a month…I don’t use heparin, and I do use supplements like Nepro, Enlive, and Procel…as for vitamin D I only take Ulta Tums!! …

Do most ppl on daily still need EPO? How is the iron administered in clinc? Please explain how you run your tx without heparin…is this everyone on NxStage or just you? Does daily dialysis reduce the need for Vit D?

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Some people don’t need EPO, because they still have their own kidneys functioning producing the hormone…

I don’t have any kidneys, they were removed…in addition to that I had parathyroid surgery so that’s why I don’t need RocalTrol or that special vitamin D…

If you need Iron then that’s given through I.V. in clinic…not orally, AckKKkk!

Heparinless treatments is how I do it daily…I have a sensitive tendency reaction to using heparin for long term so I had to stop it…it’s common for people doing long term dialysis that they develop antibody reactions with the use of heparin…so merely I just take a baby asprin every other day. You also have the option of rinsing the dialyzer every 30min with 50 saline but I never needed to do that…

Remember, everyone’s body is different so my daily dialysis dose has different parameters than the person next to me…I needed these adjustments, may be you don’t.

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Here is a good article that outlines the impact of more frequent dialysis on one’s need for EPO and other medications:
http://eneph.com/pdf/v33n2p64.pdf

The thing to remember about anemia is that there are two things going on. On the one hand your kidneys may not be putting out enough EPO but the other issue is the longevity of your blood cells. I think in a healthy individual blood cells last about 120 days, while incenter dialysis patient’s cells last about 60 days/ half as long. So I can imagine that with more frequent dialysis blood cells are lasting longer because the blood is cleaner. Dirty blood (high uremia) may have a large impact on blood cell longevity.

This matches my experience. For the 11 years that I dialyzed in center I received between 5,000 and 6,000 units of EPO per a treatment. When I started daily hemo the amount of EPO I needed decreased steadily. For a while I needed just 3,000 units a week; then it would be held for weeks at a time then months at a time and now I have not had EPO since July and my most recent Hemoglobin was 14.4 for a 'crit of 43.2 - pretty much normal for an adult male.

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Cathy writes:
On the dialysate screen on the Fresenius machine, the top number on the left is the ideal conductivity, it is what you “should” be getting considering the mix of chemicals. Mine is often off by .2. Yes, I also have the hand held meter to double check the conductivity, it is also generally within .2 which is good enough for me.

Jane- I was never taught the term “ideal conductivity”, but yes we are talking about the same thing and we get the same results in-center as you do at home with handheld meter.

Quote:
Jane- I can handle a 142 sodium too, although I feel even better with a 140 sodium. But to run a 140 sodium I have to have an initial conductivity of 14.3., and then also, I do not need sodium modeling, just a straight 140 sodium.

Cathy writes:
Are you saying your conductivity varies alot without the modeling?? I don’t find that mine varies more than .1-.2 during the entire treatment. I don’t think it should really change much, especially in center, when you aren’t dealing with a bit of settling of the bicarb.

Jane- I am saying here that my ideal conductivity varies a lot, because our bicarb is mixed in a large vat and the way it is mixed affects the outcome of the conductivity. The ideal cond. could be as low as 13.4 or it could be as high as 14.3. This is very bad in my opinion, although company regulations would say it is safe. You should not have this huge variance as you are probably using a premeasured jug of bicarb or mixing your own solution at close to the same level each tx.

Cathy writes:
You get training in that you understand what is going on. I make no changes without permission, although my permission is that I can decide what sodium (between 140 and 142 to run at), I can play with my bicarb although am running constant at 40 right now to see if I can get my CO2 up to a decent level, I can choose my U/F profile etc. I’ve never tried Sodium modelling and might ask about experimenting with that too, but right now I’m not having any dialysis issues so think it probably best not to risk it.

Jane- As I was saying previously, if my ideal cond. is 14.3, then I can run a straight 140 sodium and feel great. But if the ideal cond. is lower than that, I run a sodium modeling program and that keeps me in the zone I need to be in. There may be a better sodium modeling program for me, but I have never gotten good instruction on how to use sodium modeling and got the current setting by taking a chance one tx. It worked, so I have stuck with it. Yes, if you are comfortable with your sodium choice than no need to try something else. I just wondered if you had gotten any instruction on how to use sodium modeling as I never have and am always looking for more info.

I also use a 40 bicarb like you due to needing to keep my CO2 up. I have never tried using a straight 142 sodium, but don’t think it work for me considering the span in our ideal cond. rates. And I don’t know enough about UF programs-tried a couple Uf programs, but they did not work for me. Feel I could individualize the tx more if I could work with sodium modeling and UF, but have never encountered staff or patients that are knowledgeable on the programs.

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I have not received any instruction on sodium modelling as I haven’t needed it, sorry.

I do think though, that you should not experience such huge swings on conductivity, I think maybe your center is not being as careful as they should be in mixing the bicarb. I’ve often wondered if low conductivity in center is the cause of so many people feeling so bad after treatments. I’ve never felt like I need to go to bed (other than the fact that it is midnight when I finish lol), or feel “wiped out” after treatments (except that time the conductivity was so low) that so many people describe.

All the more reasons to do home hemo, even if you have to do 3x a week, YOU can ensure that everything is right for you (plus you can run longer than 3 hours which would give you better dialysis)