On the contrary, Pierre thinks Short-Daily is not gentle, but based on my own experience its is as I have felt the difference between conventional in-center 3x a week and daily-short. …with over 20 years on dialysis I think I have enough experience to feel what i feel…
The patient we know who is now using NxStage is also a long term patient and he told us that the daily txs of under 3 hrs are much more comfortable than in-center dialysis and he has very good energy when he gets off tx. So, I defintely believe you on this Gus.
Gus wrote:
As far as the goal its all dependent on the patients needs…for example, If I need to take off 2.5 but I don’t gain 2.5 on an average basis then I don’t remove all of it, only 1/2 - 1/4 of it…though I can remove it all in one go its not worth it…as I will dialyze the next day…get it? its all spread out evenly…on the other hand if I gain 2.5 on an average daily basis then I’d decide to run for 3.5 -3.7 hours or more…
But did your nurse trainer tell you how much you can safely remove in a tx? Yes, everyone would be different. The gentleman we know said he regulary removes 1-3.O a tx in under 3 hrs no problems. He said he is less thirsty with NxStage, too.
Are you talking pounds or kilograms when you say the patient you know takes off 1-3 per treatment? This would make a huge difference since each kilogram is 2.2 pounds.
When patients do 3 treatments a week, doctors and nurses advise them to keep their weight gains to 2-3 kilos between treatments. This is with a day off between treatments. Using that as a guide, I suspect that when you have no day off between treatments, you should gain no more than 1-1.5 kilos (2-3 pounds) per day, but I’ll be anxious to hear what people that are doing daily (or nocturnal) home hemo say.
Here, we’re told we have no fluid limit, but with the proviso that it’s best not to have more than 2 kg. This is in case a treatment should be missed due to a technical or other problem. That way, you can wait another day for the next treatment. It’s important to realize that when we say a 2 kg gain, it means at the end of the day, before treatment. Because we all lose fluid during the day and night via breathing, perspiration and even a bit of urine, this means that to end up with a 2 kg gain, we can probably drink 3 litres. Typically, without watching my intake at all, I end up around 1.5 kg over daily. After the off day, many nocturnal patient have gained 3 litres. But in practice, this is drinking whenever I feel like it, so there’s no “practical” fluid limit. Even 3-4 litres is easily and slowly removed over the course of one nocturnal treatment.
Short daily is the same, except that there are fewer hours to take fluid off, hence a higher UF rate and the need for more caution with regard to intradialysis BP.
Our maximum gain is 4 litres. We can do a max of 10 hours with a max UFR of 400ml/hr. It seems its preferred that you gain no more than 2kgs between treatments. I am battling to keep it below 3-4.
Beth,
I am saying kilograms. In his program, he can go about a max. of 3 ks per tx which is an hourly UF rate of about 1.2. But the question is what determines how much fluid intake is healthful on a daily basis? Sure, one may be able to pull off 3 or 4ks over the span of a nocturnal tx and less on a SDD tx. But what is healthful as far as pressure on one’s heart etc?
A UF rate of 1.2 is quite high. I would be trying to get it lower than that. I dont go over .8 if Im on a 5hr run. You could pull off alot more on nocturnal, but there is no guarantee that you wont go flat while your asleep. Plus theres the fact that gaining too much fluid is bad for the heart. But its never easy to stick to the restriction :?
I’d suggest that the patient talk with his doctor about how much he should gain per day and the consequences of gaining too much. Large weight gains are associated with high blood pressure, an enlarged heart and other cardiac problems including a weakened heart muscle. Here’s an article on dry weight that discusses how difficult it is to assess “dry weight” and consequences of too low or too high dry weight.
I think 1.5 or higher is scary…but I noticed something, you see, with 1.5 or higher in-center I wouldn’t reach my goal often and on daily-short I can… …but I don’t average at those gains… today I only needed .3 off…tomorrow, maybe .3 -.5…
Yes, for example, 3x a week I would need from 1.5 or higher to be taken off within 3 hours…most of the time I would come in at 2.5 … :x
Anyway, I would never be able to take it all out in one go…but now that I am at home I can easily take it out, the reason for that is the optionn of beeing able to dialyze longer…if my prescription is 2.5 hours on normal circumstances for weight gains of .3 - 1.2 and then another day I gain over 1.2 then I can dialyze 3.5 - 3.7 hours to compensate for that gain…
My rate is almost always 1.2 per hour and I never “go flat”, I’ve gone as high as 1.5 when I’ve missed a couple of days for whatever reason. I like to get it off early and then speed up the dialysate rate.
That’s true and one of the things about short-daily is that you never go thirsty crazy like in-center!..perhaps could be that sodium profiling options that the standard machines have?
1.5!! OMG :shock:
How much fluid are you taking off in total Cathy?
Most Ive done is 1 litre when I was very overloaded from machine breaking down and nurse stuff up. My BP did drop but they managed to keep me going at that rate with the bed head tilted right back and my feet in the air. That was in HDU, dunno if they run anyone at those rates in the normal Dx unit.
I use nocturnal NxStage six days 8 hour txs. My max UF is 2kg. My rinse back is .3kg and my IPO is .3kg. So I tend to gain about 1.4kg or less. That is a UFR of .25. With a UFV of 2kg. My BPS is 250 very gentle indeed. I always have a partner and was told to never go on the machine alone. So I am not to worried about complications. Well in the sense that I will have someone to help in the event something happens. I never cramp even on In-center were it was common for me to pull more then 4kg off in 3hours 45minutes. Not everyone can handle that, most people can’t and I realy shouldn’t of. I need a high fluid intake to help counter my constipation. I have encapsulating peritonitis and it abstructs my bowel. The Home txs have made it worse. I takes tons of docusate for it and it is still rock hard and painfull. TMI… sorry…
LSB :evil:
@heather, The home Hemo does not give me time to rehydrate my bowel. I am on the machine everyday removing fluid. I try to keep my fluid removal low, but it still removes some. The removal of fluid drys out my bowel. Sometimes with the incenter I would drink a ton of fluid during the week just to keep going to the bathroom. Then on the 2 day off I would pull the reigns back on the fluid This worked and I sorta use a simular method with the home hemo. On my break day I drink more fluid and try to work specificly on my bowel movements. I have bowel obstructions or Iliouses that it hard for my to digest food through my intestines. This is from the encapsulating peritonits.
encapsulating peritonitis attacks scar tissue making more fibrous stuff. My surgen Dr friese at UCSF ( an amazing man ) is very well versed in encapsulating P and he is against doing any surgery untill it is life or death. I agree with him 100%. He has done most of my work since I started dialysis. I have watched him go from a young man to a very experienced greying middle aged man. I hope that sounded right and he has watched me through my changes as well…
LSB
LSB,
Meant to say welcome to the group. Think you are the first person here who is doing nocturnal with the NxStage. Did you ever do short daily txs before doing nocturnal txs.? Would be interested in your impressions of both.
Read the article you shared on encapsulating peritonitis. Do you know what caused it in your case?
…but I don’t average at those gains… today I only needed .3 off…tomorrow, maybe .3 -.5…
and he has watched me through my changes as well…