Fresenius harsher than a single pump?


#1

For the last months, since I’ve moved I’ve been using a Fresenius 5008s, for home heamo 4 times a week.

As I understand it the second pump allows some re infusion mixed in during the dialysis process to remove more large molecules. However I’m find I’m more exhausted than normal, albeit I’m going on much earlier. I can only describe the treament as ‘harsher’ compared to my old Gambro, with its one pump. My results aren’t much better overall, but aren’t awful either…

Just wondering about others experiences


#2

There are several things to take into account before a guess at prognosis can be made.
What size kidney/
how long do you dialyse for?
what pump speed and what diaysate flow?
have your blood results changed at all?
We can then chew the fat :slight_smile:


#3

Parameters all remain the same. Apart from the change in the machine and location.


#4

The 5008s is a more efficient machine. For example, I was am doing 3x4hrs/wk using 14G blunts. I moved onto a 5008s in centre from HHD on a Gambro. In centre I ran at 450 blood and 530 dialysate. This I have learned is not good and was exacerbating my LVH heart problem, such a fast blood flow puts more strain on the heart. Also it is now believed that a pump speed over 400 will inhibit the removal of middle molecules. I am trialing now for 2 months with a pump speed of 360 and a dialysate flow of 720. After 3 weeks there is already an increase in blood pressure on both S and D.
Finally maybe the kidneys you are using need to be smaller


#5

Pump speed and flow rate have been 330 and 600 for a long time due to prev heart issues (currently non existent) , and to prolong the age of my 27 year old fistula.

I agree this urge to get more litres processed with insanely high pump speeds and flow rates might give good clinical results but don’t do the patient much good in terms of cardiac health.

It seems the op may remain unanswered . Such is life:)


#6

Upping the flow rate to 800 should help with clearance. How are you feeling energy wise now you have been on it for a while?


#7

Here’s an article on the Home Dialysis Central website written by Dr. John Agar of Australia who warned of high blood pump speeds and potential harm to fistulas.

More home HD patients are choosing to do longer dialysis treatments (sometimes nocturnally) or choose short daily dialysis (4-6 days/week) to maintain better dialysis adequacy and feel better. In-center dialysis clinics run patients at very high blood flow rates to make it possible to provide minimally adequate dialysis, to dialyze more patients in a treatment day, and to be able to bill for more patients and make more money.


#8

My clearance is fine. Its never been an issue. Thanks for the response tho, I may go over some of those points tomorrow at my appointment.

Seeing my consultant tomorrow, and reduced dry weight to start with. Which should have been suggested in the first place I think… I may be an experienced patient but sometimes even we don’t think of the obvious!


#9

Not just in the USA, often read of higher pump speeds on the UK forums and wonder if its wise. Shorter daily (with NXstage) or nocturnal is generally being encouraged where possible for patients in the UK, and generally we’re ahead of many countries in Europe that still prefer in centre treatments.