Educational Training for Home Hemo

Did I understand you to say that you are using a FR machine (which one?), 5hrs a day, 6 days a week? Excuse me if I missed a previous post, but wondering why you do 5 hr per day txs? I thought 2-2 1/2 hr txs were sufficient on daily. Did you find that you needed more time? Do you feel totally better than 3x week short txs? How is it paid for?

Definately, along the way you will be given materials to study, things like how dialysis works, vital signs and so on…and you will also be quizzed on all these things you studied…then there’s a final exam…

[b]Not sure if it was intended for me or Bill but in a recent post I mentioned a patient I’ve met using NxStage for 5 hours, but he doesn’t dialyze daily…only 3x week…

I myself do 2 1/2 daily…I use to do 2 and 9min…but decided to run a little extra…the reason for that is more clearance from particles in the blood…but the best choice would be Nocturnal which actually is longer…up to 6-8 hours per night…but the parameter settings are gentle…slow pump speed…perhaps 200, which doesn’t stress the body…almost like having your own kidneys…[/b]

As I mentioned I am supposed to be doing nocturnal, but I can’t sleep on the machine and frankly am a bit concerned about dislodging a needle in my sleep. Since I do dialysis without a partner they won’t allow me to do fast daily since, in their opinion, the increased blood flow rates and faster fluid removal can cause more problems with blood pressures dropping. I don’t need much fluid removal (in fact generally drink about 3-4 cups while on the machine to enable it to remove between 1500 and 2000ml since I’ve heard that dialsyis is better with a bit more u/f), but so far haven’t convinced them to let me try shorter runs at a faster bfr. Maybe with a few more months under my belt.

I only run at a bfr of 300, most 2 1/2 to 3 hr daily runs are at 450 or so.

I really wouldn’t obsess about getting manuals and other materials before starting home training. I hadn’t even done dialysis before I started my home training and stuck every needle except the first one and was home after 4 weeks. It isn’t really all that difficult to learn.

I run a blood pump speed of 350 mml/min I think high effiecency dialysis requires a blood flow greater than or equal to 350 otherwise I’d probably try 300. When I did the nocturnal study I ran at 250. I’m sure 250 is easier on my fistula but to me it is all about striking your own balance with the options that are available and fit your life.

Bill said:
I run a blood pump speed of 350 mml/min I think high effiecency dialysis requires a blood flow greater than or equal to 350 otherwise I’d probably try 300. When I did the nocturnal study I ran at 250. I’m sure 250 is easier on my fistula but to me it is all about striking your own balance with the options that are available and fit your life.

Please elaborate.

Cathy wrote:
really wouldn’t obsess about getting manuals and other materials before starting home training. I hadn’t even done dialysis before I started my home training and stuck every needle except the first one and was home after 4 weeks. It isn’t really all that difficult to learn.

Not concerned about the difficulty of getting trained. Simply ready to ed. myself now while I’m still in-center. Interested in knowing how the whole thing works and could be info there that would help me with my in-center txs too until I get to home program. Still looking for a program to relocate to if my nephrologist will not start a program.

Cathy wrote:
only run at a bfr of 300, most 2 1/2 to 3 hr daily runs are at 450 or so

My understanding is it is not wise to run a fistula at more than about 300-350. Personally, I can not run higher than 350 or feel pain in my access and pressure on my heart. I have always run in-center at this rate and achieve good clearances. Have you heard of anyone whon does short , daily txs at a 300-350 bps?

Indeed that is true, …the highest I’ve tried is at 410 and I’ve tried 420 but felt uneasy…now I’m at 370-390 daily for 2 1/2 hours…I only remove from .5 - 1.0kg of fluid daily…I have my fistula for 25 years now and had a few revisions…truly I do believe high pump speeds can be damaging, espcially to nerve tissues…if I can still get good lab results at 300-350 I would definately decrease my pump speed…

Here is a link to the online edition of the Atlas of Diseases of the Kidney:
http://www.kidneyatlas.org/toc.htm
Chapter 5, Section 3 explains High Efficiency and High Flux dialysis.
The Atlas notes that High Efficiency Dialysis is defined as having a blood flow rate greater than or equal to 350 ml/min, and a dialysate flow rate greater than or equal to 500 ml/min.

I’ve done short daily for three years at blood pump speed of 350ml/min