have not been on line for awhile but would like to report on my experience with NxStage - after doing nocturnal for about 6 months.
my treatments are 6X a week and last just over 2 hours. set up is pretty easy now that I am used to it, have learned that beating up the dialyzer pretty well dislodges just about all the air and prevents alarms during treatment.
my biggest complaint is all the garbage produced by the bags and the bags to contain the bags, as well as the cartons for the bags. wish NxStage could come up with something more ecologically friendly. on the other hand I am not using all the water that nocturnal used.
other than the cleanup I am happy with NxStage.
How long have you been on NxStage now and how do you feel doing short daily as compared with long nocturnal? How liberal is the diet of short daily compared to nocturnal?
as to the question of diet, at first my potassium (K) was on the high side but last couple of labs it was 4. something.
one negative feature, but only moderately, is it doesn’t pull phosphorous the way nocturnal did so binders I must take. at first I barely remembered to take them. it doesn’t sound all that bad but I eat all day long so have to remember what is high in phos. and what I can skip the binders.
if you gotta be on dialysis I guess its as good a system as is out there.
Are you saying you can eat more phosphorous and potassium foods on short daily, then on 3x hemo, but just need to take binders? But can you eat as much phos. and potass. foods as you did on nocturnal? And what about energy… more energy on nocturnal or daily short?
energy? what’s that?
energy for me is a seasonal thing, very much affected by the weather and other conditions. I guess I won’t know what energy is until I am recovered after my transplant (oh, please God!).
as for diet, when dialyziing daily you can increase your potassium because you cleanse more often. I still stay lower in K than before but am now eating more fruits and veggies, saving high K foods for shortly before hooking up. ditto with phosphorous but have the high phos. foods rarely and follow immediately with a binder.
Gus, of course I climb walls, especially in winter when its too cold or nasty out to go anywhere.
So, you’re saying that dialyzing short daily has not increased your enregy? Neither did nocturnal? And as far as diet, could you eat a bannana before dialyzing or a half of a cantaloupe? And phos. foods are still almost as limited as with 3x hemo? Could you eat more phos. foods when on nocturnal?
energy? what’s that?
energy for me is a seasonal thing, very much affected by the weather and other conditions. I guess I won’t know what energy is until I am recovered after my transplant (oh, please God!).
Spiderwoman, have you told the doctor and home training nurse that you have little energy? How are your labs (adequacy, anemia, nutrition) and mood? Are you doing any physical activity that could build your strength and endurance? As I’m sure you know, so many things can affect energy level…
spiderwoman, how do you get medicare or your insurance to pay for the daily tx’s for nxstage? when you were doing noctunal could you have done daily short runs like you are now on the nxstage?
Medicare pays it really…however, reimbursement rates are about the same as the 3x a week…
The tradeoff over doing home hemo is that I think it cuts costs in most cases…there’s no in clinic staffing and maintenance costs because your not in clinic anymore…also, hospital visits will be rare because your having dialysis more often now…
Please read more detailed information on how the process works here
http://www.reimbursementconnection.com/epogen/office_managers_info/home_dialysis.jsp
I suppose my energy levels are as normal as they should be for an ESRD person on dialysis. my labs are fine. its just that winter or very hot weather depletes my energy. I do best in spring and fall.
as said before, payment for daily (or 6X a week) dialysis is not a problem since costs are lower. staffing is the biggest cost for dialsis in center.
home hemo programs exect to take a loss until they build up a big enough clientele. I once heard that it takes roughly 25 patients to break even.
I’m not disputing the fact it could take 25 patients to breakeven on daily dialysis but I was told on nocturnal it would take 16 patients and this was taking into account the computer monitoring.
Medicare pays it really…however, reimbursement rates are about the same as the 3x a week…
According to the Medicare intermediary manual (the manual that tells the insurance companies that contract with Medicare what is covered), Medicare should reimburse for only 3 hemodialysis treatments a week (maximum of 14 a month). The amount Medicare pays is 80% of the Medicare composite rate for the type of clinic and its location (about $140/treatment). Of this, the clinic gets about $115 a treatment (not counting any drugs or other billed items). From the Home Dialysis Central website you can click on a link to read more Medicare FAQs for patients or professionals.
I’m not disputing the fact it could take 25 patients to breakeven on daily dialysis but I was told on nocturnal it would take 16 patients and this was taking into account the computer monitoring.
The costs for any form of home dialysis should be less than the cost of full-care in-center hemodialysis where clinics have to pay for more for labor costs and clinic overhead. However, how many patients a clinic needs to breakeven depends on the costs for a home dialysis program. I suspect how much it costs a clinic to have a home hemo program depends on such things as:
– How much the nursing and other personnel assigned to the home program cost. More experienced staff usually cost more.
– How long it takes the average patient to train. Clinics get only $20/day for training when patients have one-on-one nursing!
– How much the machine and supplies cost. Large dialysis corporations pay less for everything than small independent clinics. Machines can be used for many years bringing the cost per treatment down, but new technology costs more.
– Whether the clinic provides other services like remote monitoring and how. From what I understand Fresenius has one location in the US from which it monitors all its nocturnal patients. Each clinic doesn’t have to pay staff to monitor its patients so costs are less. However, if an independent clinic chose to do remote monitoring, costs could be much higher.
Beth, I think but can’t swear to it. Fresenius has 2 places that monitor. 1 in Indiana and another in Pittsburgh, Pa. Just another tidbit of information. I know that at 1 time our center was willing to let other centers who wanted patients monitored be monitored by them. This would reduce the cost for both centers.
spiderwoman it is good to see you posting again. What can you tell us about nocturnal compared to short daily? Do you miss having your evenings free? or are you more rested?
evenings are not usually and issue because I dialyze in the afternoon when I watch Dr. Phil, Oprah etc. it would be nice to sleep through my treatment but nothing is free. there is a cost to dialysis and it is time. I do try to use it to my best advantage, reading, catching up, whatever.
in an earlier post someone stated 2 centers did monitoring. add Rogosin in NY to that who monitored me on nocturnal.
I believe there is another center in NYC that monitors but they don’t do nocturnal. I originally applied to them but needed a partner for the training and my sig. other could not leave work for that time.
Did you have to have a liver function test prior to switching machines? Switching to a lactate based dialysate as opposed to bi-carb?
nobody mentioned liver function but I have all kinds of blood work done.
should I be worried about it?
Bi-carb based dialysate would have storage issues so the NxStage uses a lactate based dialysate. My understanding is that the liver processes the lactate. The liver converts lactate to bicarbonate. Those with severe tissue acidosis and/or liver failure, may be unable to convert the lactate. The result would be acidosis. I think this is also the case for citrasate.
I haven’t read anyone talk about taking a liver function test so maybe the amonts involved make it a non issue.
So what do you think? Lactate Versus Bicarbonate…PD patients use lactate based solution for their treatments…
I wonder what’s best…