I dont want to alarm anyone whose been thinking about switching to NXSTAGE, but I’ve noticed an increase in my dry weight since I’ve started. and I dont see anyway how it can be because I’m eating more, because I’m actually eating less - and more healthy. (I am ALWAYS hungry, I’ve just been cutting down on eating by choice!) My dry weight when I started in December was 58 kilos, and now its 62.
Not to sound like a complete ignormaous, I remember PD could make you gain weight, do any of you NXSTAGE users believe that the diaylsate being used - could be contributing to this? Even though, from what I understand, the diaylsate never actually mixed with your blood… :?:
a small weight gain should not discourage anyone from NxStage dialysis. in general a gain of weight is a good sign of wellness, also it may very well be muscle gain and not fat.
don’t know your lifestyle but are you more active? that would cause increased hunger, but in someone on dialysis that is a very positive thing.
weight, like age, is very subjective, both are only numbers and have little to do with the way a person feels.
eat good, healthy foods, lay off the junk and don’t worry about what the scale reads.
I heard that patients on short daily can consume approx. 50 % more phosphorous and potassium foods. Is this correct? Therefor, would explain why there is a small weight gain. But the weight gain couldn’t be that much as one is still limited by how much phos. and potass. can be consumed.
What did your nurse trainer tell those of you who are on short daily txs you can eat as far as extra phos. and potass.? For, ex, could you eat one or two oranges or bananas a week, peanuts or a milkshake? Or must you still be real careful and only have a few extra super small portions of these foods per week?
Jane, there isn’t any magic number. Some people on 3x a week dialysis don’t have many restrictions as they have some residual kidney function, some people on daily still have fairly strict restrictions.
In general, most people get a greatly reduced restriction on daily dialysis, people can choose what foods they prefer to eat, we are given a daily “allowance” for phosphorus, potassium etc. Depending on our monthly labs we add or delete amounts to keep our numbers normal.
I’ve personally been having problems with my phosphorus, it has ranged from 2-7.5, we believe some of the problem is with my calcitriol and I will be trying hectorol to see if it stabilizes. Dialysis isn’t the only consideration. I also tend to run a higher calcium since starting dialysis even though I have a very limited diet of calcium, we’ve lowered my bath and again think the calcitriol might be the contributing factor. Unfortunately my insurance won’t cover either Hectorol or Sensipar, both of which might clear up the problem.
What I am trying to say is that there are no magic answers, it isn’t an exact science. Everyone is different and I would hate to have you disappointed when you start. I would think it is pretty much guaranteed that if you go on daily dialysis your diet will be less restricted, most likely if you do nocturnal it will be even more liberal, I can’t imagine that diet is your most important consideration, it is just another one of the benefits of daily or longer dialysis, for me the most important is health.
From my point of view, doing 2 hour short daily, and on my way to going nocturnal in a couple of weeks, I found that my phosphorus number became normal the very first time they did blood work - which as I recall, was after the first week, and it has stayed normal, despite eating quite a bit more phosphorus. But, I think I still have a fair amount of residual kidney function, despite 2 and a 1/2 years on hemodialysis.
With short daily, you’re not really getting much more actual dialysis time per week than with conventional hemodialysis. The difference is you’re getting it every day except one, so the so-called “unphysiological” effects of dialysis are lessened, and so you feel better. It may help with fluid, potassium and phosphorus, but, I think it’s safe to say that this will vary from one person to the next, the same way it varies even on conventional hemodialysis.
I’ve come to believe that the first hour of dialysis is the most efficient/effective hour of dialysis. So I believe the more first hours you get the more dialysis you are getting, or the more dialysis impact you are getting. So frequency has a bigger impact than adding time. But adding time and frequency is best. To me it is striking a balance one that will be different from person to person and different for the same person from time to time.
Bill writes:
I’ve come to believe that the first hour of dialysis is the most efficient/effective hour of dialysis. So I believe the more first hours you get the more dialysis you are getting, or the more dialysis impact you are getting
Do you know where an article can be found re this?
There is an article called “Rationale for Daily Dialysis” by Umberto Buoncristiani, Riccardo Fagugli, Giuseppe Quintaliani, Hrissanti Kulurianu that was published in Home Hemodial Int., Vol. 1, 12 – 18, 1997. You can find the full article at http://www.multi-med.com/homehemo/buoarticle/main.html. It describes how most of the urea is removed during the first two hours of dialysis and then urea removal stabilizes after that.
How technical an article are you looking for? I like using Google Scholar to get actual technical data. For this topic try: solute flux and solute transport along with daily dialysis and/or quotedian dialysis. Also remember to try the spelling haemodialysis.
I like this article to start and it’s readable: http://www.eneph.com/pdf/v31n1p13.pdf
It’s the article by Dr. Scribner on his dialysis product. Talking to Scribner was the first time I learned about the need for more frequent dialysis and the flukey way we got a three day a week treatment standard.
The Google searches turn up mostly only abstracts for free … the actual articles/papers cost money. Here is one that is posted and free:
“During HD, both urea and phosphate decreased in
blood/plasma and in the collected dialysate, however,
with different time courses. While urea concentration
and urea removal kept decreasing with time by an
exponential relationship (Figure 1 ), phosphate
concentration rapidly dropped during the first two
hours of treatment, but remained stable thereafter
(Figure 2 ). Dialytic phosphate removal was highest
during the first hour, then it slowed, remaining
constant during the last 2–3 h. Hourly urea mass
removal continuously decreased from 33±4% during the
first hour to 12±2% during the last treatment hour…”