February 6, I will be learning the NxStage and Pureflow to do Nocturnal NxStage with dad. Hopefully, I will find that I love the NxStage and dad’s labs remain good. After over 6 years on Fresenius H, with very few alarms and very few problems with the machine and great dialysis I am a bit skeptical about how well we will adapt to the difference in the machines.
I switched last March and have never looked back. I feel fine, even better, on the NxStage, and love, love, love not having the r/o and all the maintenance. I am fairly sure you will not notice a difference, I sure didn’t.
home hemo 9/04
Cathy, Thanks, for your input. Pat says her husband Ralph feels better also. Sure am hopeing we have the same results. Over 6 years of the setup time on the Freseni, the cleaning cycles and the RO’s. I’m ready for a break.
I had my first run at home on the PureFlow/System One last night Marty. I’ll post soon (I’ve been off line for a few days but should be back on again soon); I will be very interestd to hear your reports as you switch over.
Good luck with it all, Marty. Will be wonderful for you to have some well deserved quality time for yourself without all that Freni preparation time. I guess it is like all technology, change is just inevitable and if it leads to a better quality of life for you and your Dad, then go for it! Heck I remember how I resisted a microwave oven and computer for years! LOL
I’ll let everyone know what I think about the difference between the 2 machines. I figured as long as I would have to change machines anyway; this was as good as time as any to try the NxStage and if I don’t like it, I can always go back to a Freseni. Bill if your running nights hope you are getting some sleep.
We use both machines for 6x nocturnal --Fresenius for 4-1/2 years and NxStage (with bags) for travel only for about a year. Set up time is about the same if you’re an experienced Fresenius user, cleanup much faster with NxStage, no water testing or R/O maintenance with NxStage, portability with NxStage, better contollability with Fresenius, noise (for nocturnal dialysers) about the same, NxStage requires external heparin pump. Storage requirements are similar, but should become much less for NxStage users who use the new PurFlow water system. I have no experience there so can’t compare PurFlow demands with R/O demands. No needle ports for meds or labs with NxStage. No arterial pressure measurement with the nocturnal NxStage cartridge which is a concern if you’re a catheter user as we are.
Telephone support from both companies is excellent.
One issue with NxStage for most nocturnal users is the #14 alarm problem discussed elsewhere which NxStage should have fixed with a revised cartridge design in a few months.
I’m not sure there is a settled conscensus among nephrologists about the long term consequences of low vs. high dialysate flow designs, but I’m not competent to express an opinion.
In sum, I think both are great machines and a credit to their companies. My guess is that the home dialysis world will go in the direction of machines like NxStage rather than the 2008K simply because they are more appropriate for home use, but the 2008K will continue to dominate in dialyis centers.
What do you mean by “better controllability” with FR?
How do you know if you need to reverse lines or the catheter isn’t working well if you don’t have any arterial pressure? Or if it gets to high does the machine just stop? I would think even fistula or graft patients would want to know their pressures. I thought there was a med port of some kind on NxStage as our nocturnal patients do their own iron. I don’t think the concensus is out either regarding the low vs high dialysate flow rates. I know I have read articles that compared an 800 flow rate to a 500 flow rate on the Fresenius and the concensus has always been the higher flow, better dialysis if your running short treatments. I’m going to be real disappointed if the setup time isn’t less. On the Fresenius we have to do a 10 min recirculation then another 10 minute recirculation with the blood in the tubing. I didn’t think NxStage did the recirculation so this should cut off 20 minutes. If #14 are a problem with NxStage I’ll switch back. I’d rather be well rested and spend the time doing the RO and machine. Then to be tired from lack of sleep and not feel like doing anything. Did you have a chance to use the NxStage at home and choose to use the Fresenius?
Marty, you mentioned that patients in your nocturnal program administer their own iron.With NxStage there is a port on the venous end of the dialyzer that can be used for giving meds. Could you ask and find out how it is that patients in your Nxstage nocturnal program can give their own iron? We are not allowed to in our program as they think we could have a reaction at any time. But also, isn’t there some state rule that units don’t get paid for iron unless it is administered in-center? This might not apply to all states. If I could give my neph information on the fact that other units like yours allow iron given at home, maybe he would order it. As it is, I have to pay for my own oral iron or go into the unit everytime I need iron IV and get an extra stick.
How does FR and NxStage differ in dialysate flow designs?
Flow rates – setting aside the #14 problem for a moment, a nocturnal patient would like to run at a blood flow rate of, say, 200 ml/minute or 12 L/hour (96 L for an 8 hour run). On a Fresenius machine we run at a dialysate rate of 300 ml/min or 18 L/hour. On a NxStage machine for a blood flow of 200 dialysate rates might be 60 to 70 ml/minute or 3.7 to 4.2 L/hour (using an FF of 0.30-0.35). With NxStage the dialyser is quite saturated compared to the Fresenius where a lot more dialysate goes through much faster.
Control – On the Fresenius machine you can set each variable independently while with NxStage they are interactive – you can’t, for example, independently set the length of the run. It is determined by the rates and volumes you set in. You can, of course, play with the rates and volumes to get the time to come out at least close to what you would like.
Needle ports – Lacking on the NxStage. For iron I go in directly through the catheter on both machines, but I prefer a needle port for Epo and for drawing post-dialysis labs. This, however, is not a show stopper, just convenience.
Arterial pressure – Catheters typically have multiple holes so when one hole is plugged by a clot you usually unplug it with a saline flush. The only way I know how to tell whether a catheter is functioning properly is by the pressure – arterial pressure in the case of the arterial catheter limb which most commonly is the one that may become partially obstructed. My assumption is that the reason they left the arterial measurment pod off the nocturnal cartridge is that nocturnal blood flow rates are so slow there is little chance of a safety issue which might occur at the higher rates used for SDD.
Set up – The time I need to set up each machine to start dialysis is about the same. The Fresenius is much harder to learn, but I think people who have been doing it for a few years would find there isn’t much difference. As I noted the big saving with NxStage is in cleanup and absence of testing and R/O maintenance.
Here’s hoping that everything goes smoothly Tuesday Marty. I am at this moment making my third batch of dialysate using the PureFlow so far, no problems other than routine pressure alarms due to arm position/movement. And I woke up hungry today - two poached eggs for breakfast - which I take as an indication of enough dialysis.
I’m doing 30L and have been “playing” with Qb. My runs can be anywhere from 4.5 to 3.5 hours. The challenge is fitting it into my life - the NxStage is adding an hour to an hour and half a treatment to the dialysis time suck, as compared to the Aksys. I think your mileage will vary switching from the FMC and doing nocturnal. My best guess is that you’re going to think it is a good fit logistically and I’d be optimistic clinically.
4 hours? What ff are you running? Are your kenetics doing good?
I’m using an FF of 35 and removing about 1.5 L total per treatment setting the UFR at .5 I start my Qb=350 and increase to Qb=450 over the first 30 minutes of treatment. I’ve only had four treatments on the System One; I did a blood draw on the 1st which will be a baseline. I think I was under dialyzed going in.
I know NxStage recommends a max. FF of 35, but we are running at 38.
I talked to several people at the company and at clinic. The best I can figure out, these recommendations were in order to get adequate clearances on as little fluid as possible (that may or may not be the case, just my impression). Anyway, my wife was using 15L at 33F. We increased to 20L to use the full 60L from the pureflow over 3 treatments. I bumped up the FF to 38 to cut the time back down to close to where we were before (approx 2 1/4 to 2 1/2 hours). If you are getting adequate dialysis, you may check with your clinic about speeding up a little bit.
Our kt/v actually got better (From 1.9 to 2.4) running more Qd (15L to 20L) and a higher FF (33 to 38) with just about the same length of time.
Well, have you ever heard the old saying “Life can change in an instant.” We received the pureflow on Friday and were about to go set it up for water samples when the phone rang. It was our dialysis center at home letting me know that their starting a home program was far enough along that they could just about guarantee us we could switch to them before 6 months.
This put me in the position of getting closer to home with the center that supports us / or staying with the Rubin and getting the NxStage.
The center at home isn’t going to offer NxStage just the Freseni Baby K.
Dad will be 83 this year and is really tired of traveling the long distance for clinic visits so he really wants to transfer to the home center. A 2hr drive one way as compared to 5.
The Rubin was outstanding in cooperating with any decision I made even offering to let us train and use the NxStage even if it was only for a short time. However, in order to do this, this meant dad and I moving to Saratoga for a week with a cost of about $2000.00 plus dad sitting in-center for his treatments which he hates, plus me learning a new machine, plus tieing up the Rubins time training and getting us connected for monitoring. Then coming home and spending the week or 2 getting in the comfort zone again.
Only to change again in a short period of time it wasn’t worth it.
I really am very very disappointed I won’t get to switch the NxStage or at least give it a try and I really hate to leave the Rubin as they are so on top of things and are so supportive and patient oriented.
But my bottom line goal has always been getting closer to home and I’m sure the first time I make a clinic visit at home and realize it isn’t going to take 12hrs will be a big relief and it will cut nephrology visit down to 1 a month not 2. Not to mention dad will get more comfortable with the staff that treats him when he does go in-center for something. My husband (I got married last year) is thrilled not to have me on the road traveling such a long distance. He is comforted by knowing should I have a flat tire or the car break down he can at least come and help me. On one of my trips to Saratoga, the transmission went out of my car when I reached Saratoga then another time I had a flat tire about 4 hrs from home. Nothing that I couldn’t handle one way or another but it definitely would have been easier if I could have just called home and said come and get me the car is broke down.
Our home dialysis center and nephrologist have also been very good at supporting us. I know they are going to allow us to do IV iron at home and they won’t have me going to the center anymore than necessary. They have always cut me all the slack they can. Teaching me how to give Vanco through the machine, telling me I could skip nephrology visits if dad had too many drs. appt in a month and dad was OK.
I don’t know if I am weak or what, but I have to admit having all these choices and decisions to make has thrown me for a loop.
I don’t think you are weak at all Marty. I think it is good news that you have the knowledge to help your dad take the best option available looking at it from all the angles.
Take a breather and then work on your new center to offer the NxStage as a travel option.
We are in the same program at Rubin that Marty is and we do our own iron also. We use Venefer. I order it from from RX company. Last year we did not have to pay fot it. It is my understanding it is $400 a bottle.
This year we are with a new Rx company and we have to pay $100.00 for 6 bottles. We use 2 a month.