Do you dialyze for different amounts of time depending on your schedule? Can all the machines dialyze for two hours one day and four hours the next?
I try to maintain a routine but I have no problem changing a schedule when I need to. In fact that is a big plus for home dialysis. I don’t think you could stretch time on the NxStage to the “extent” you can stretch the time on the Fresenius but you can stretch the time. I think if your using the Aksys you have to consider the machine cleaning cycle to vary your schedule as far as the days you want to run not so much in the time you want to run. With the Fresenius it’s no problem changing days or time.
It says on NxStage’s web site that the machine can do short or long txs. I have read that all the machine for home hemo can do long txs with the use of a stand alone heparin pump. So, there are some patients doing long txs on NxStage and PHD.
I think there’s more to nocturnal than just using a standalone infusion pump for heparin.
Pierre
In my case scenario,
schedules change now and then and when that happens so does the treatment times.
Its been flexible and have been able to run longer on other days…
For example, my prescribed suggested treatment is 2.5 hours, but have also dialyzed an extra hour…
So the answer is YES! on the NxStage System One
Yes schedules do change. Rubin Center in Saratoga NY monitores us on the internet. We do not do BP’s every half hour.
But they monitor every thing else. We have the pre and post BP’s Temps and weight we have to call in to let them know.
Pat
Pierre, I think it would also need to have enough dialysate to last through longer treatments. I also think in some cases it may be a state law that nocturnal patients have to be monitored by the center. So a monitoring device would have to be incorporated into the machine.
This is what I was wondering, that is, whether a person could setup enough dialysate at the start to last the night. There isn’t much point to doing nocturnal unless you can sleep through it.
Also, is it possible to add phosphorus and calcium to the dialysate on a NxStage? Both, and certainly phosphorus, are needed for nocturnal most of the time. I’m not sure how lactate-based dialysate would work for nocturnal vs the standard bicarbonate. Can a NxStage run effectively at the lower pump speeds and the very low UF rate? Is the alarm system effective and reliable enough to be triggered by any situation that might arise during a whole night of treatment while the patient sleeps? The same questions would apply to Aksys PHD. Could either of these systems stand up to 8 hours of treatment every day? I guess both systems would have to specifically pass clinical trials for nocturnal use. I’m not sure they have at this point, even though they mention nocturnal on their websites.
Pierre
Pierre I dialyzed on the Aksys six nights a week for eight hours, five weeks in a row – the machine did great. All I’d need to do it again would be the stand alone heparin pump – there isn’t any additional FDA approval needed. I could dialyze for eight hours during the day without a heparin pump – I’d just need to manually infuse heparin.
As far as adjusting the dialysate the PHD has, I think, 35 combinations of acid and bicarb available. When I did nocturnal I just ate ice cream – a lot of ice cream. The potassium shouldn’t be as big an issue – the potassium in the bath acts as a floor.
I change my run lengths all the time – I can change my run length before or during dialysis. I’m currently in the midst of doing 11 treatments in a row to prepare for a quick trip to Philly (I’m visiting the B Braun factory in Bethlehem, PA) so I’ve reduced my run length to two hours during the week since I’ll skip my day off.
Gus when you lengthen your run do you hang more dialysate? I still don’t understand how the ultraslow dialysate flow rates work on the NxStage. How could you hang enough dialysate to do a long run? or would you have to go to a standard RO? The low lactate flow rates still seem counterintuitive. If allowing the dialysate to dwell along the semipermeable membrane is effective then why not send the dialysate and the blood through the kidney in the same direction? I’m still waiting for a paper to explain the theory.
Bill wrote:
How could you hang enough dialysate to do a long run? or would you have to go to a standard RO?
I read a post on this once. The person said it took him about 4-5 bags for a 8 hr nocturnal run on the NxStage. The UF can be shut off sooner and the tx can continue as long as it is set for.
Bill wrote:
I’m currently in the midst of doing 11 treatments in a row to prepare for a quick trip to Philly (I’m visiting the B Braun factory in Bethlehem, PA)
We’ve heard good things about this machine. Please share any info. you find out about it.
Yes I do, basicly just add another bag…the machine by default can handle 6 bags…
In order to run much longer I can adjust dialysate flow rates, blood pump flow rates…
Thanks for the information, Bill and Gus. I’m only asking the questions out of interest… not being critical of any particular system.
As far as phosphorus and long daily treatments like nocturnal, I’ve found that there’s just no way I can eat enough phosphorus in a day to compensate for the low phosphorus which results from just a single treatment. Without adding some to my dialysate, it ends up way below the normal range. It’s slightly below normal range even with the added phosphorus. Same thing with calcium when it’s needed. I could eat a tub of ice cream a day and drink a 6-pack and it wouldn’t be enough - although it would probably be enough to make me fat 
In terms of varying treatment time, this is something that they don’t want patients to do on their own where I live, except within a narrow range if you happen to have so much extra fluid that it would cause the UF rate to be too high (> 500 for nocturnal, and > 1100 for short daily). Not usually a problem on nocturnal, but it can easily happen on short daily.
Pierre
Pierre wrote:
In terms of varying treatment time, this is something that they don’t want patients to do on their own where I live, except within a narrow range if you happen to have so much extra fluid that it would cause the UF rate to be too high (> 500 for nocturnal, and > 1100 for short daily). Not usually a problem on nocturnal, but it can easily happen on short daily.
You are speaking here about not varying the tx length in re to higher fluid gains. But if fluid gains are not a problem and one who is on nocturnal txs wants to do a short tx every now and then what would have to be adjusted in the tx peramiters?
On the Fresenius nothing. Pierre, we have the option of pretty much any schedule we want. If I need to do a short daily, I just call the nurse and tell her because someone is always in center during the day in case of a problem. If it’s a short night I want, I just tell the monitors I’m coming off early. I agree with you about the Phosphorous there is no way dad could get buy without adding it to the bath. Bill, I wonder how much longer Aksys is going to keep using their machine. Since the time our homecenter signed a contract with Aksys 6 months ago they let their sales rep for our area go and now say they won’t provide service. Our center is back at square one trying to decide whether to go with the NxStage or Fresenius for a daily program.
Pierre, Even with the NxStage as it currently is I was told dad could use the machine even with his catheter the blood pump speed can be slow you would just have to run longer. When I go for buttonholing, I’ll ask about the Phosphorous issue. I know our center knows NxStage is working to make the machine nocturnal compatible I would guess the phosphorous issue is being addressed as they certainly know nocturnal patients need it.
Hi Heather, Hi Marty
I can do an occasional short daily instead of nocturnal anytime I want, and I don’t even have to tell them. What I meant by not varying treatment duration is that a standard short daily is taken to mean 2 hours, and a nocturnal is taken to mean 6-8 hours (and you have to decide and tell them what your choice is for most of the time, having to do mostly with how long you want to sleep - otherwise it can affect blood work and the resulting dialysis prescription). If something comes up, I can miss a treatment or I can do a short daily. There is no remote monitoring for us. In our system, doing conventional length treatments daily (like 3 or more hours daily like some of the members in this forum do) is not considered to be “short daily”. Short daily is 2 hours, maybe 2-1/2, but of course, doing an hour is better than none at all if you have to.
In answer to Heather’s question specifically…
If I decide to do a short daily one day, I set the dialysate pump to 500 and the blood pump to 400 instead of 300/300 on nocturnal. I also don’t add phosphorus or calcium to my dialysate for that treatment. Everything else is the same, except of course, I set heparin to stop an hour before the end of the treatment. The only reason for making a short daily more than 2 hours is if I have so much fluid to take off that it would result in a UF rate of more than 1100 ml/hour. In that case, I can either lengthen the treatment a bit, or I can just take off less fluid on that particular day.
I can also vary the time I want to start treatment anytime, but as I’ve mentioned before, this ability is more limited with nocturnal simply because I don’t want to get too sleepy before I start the prep, and I don’t want to have to get up too early either - but I certainly can if I want to.
In practical terms though, I find that I never want to vary too much from my usual schedule, and I almost never do a short daily. What I do instead if there are things happening in my life is that I vary the nights I take off, while keeping to the same total number of nights per week.
Pierre
Hmmm…so there is short daily, daily and daily nocturnal? And is daily really daily? I think there is a language issue here. Maybe we should use the word quotidian since fewer people know its true meaning.
Maybe the solution is less parsing –should we seek a broader phrase? Home Wellness Hemodialysis? More Frequent Home Hemodialysis? Optimal Home Hemodialysis – OHH. As in OHH now I feel better.
dang … I could have sworn I had logged in.
I’ve had that happen – log in two or three times and still not there :lol:
BTW, I like OHH.
Bill,
It’s not that I’m a stickler for the exact meaning of terms, but there’s a reason “short daily” is called “short daily”. It’s because it’s “short”. First, technically, it’s based on the idea that most of the dialysis occurs in the first two hours, and so doing dialysis daily for 2 hours should be enough. Secondly, it’s one thing to do 3-4 hour treatments 3 times a week with a one or two day break in between, but personally, I think most people would find doing more than 2 hours of hemodialysis on a daily basis forever is intolerable. That’s half a day of every day, and 3 times per week of that is intolerable enough as it is! Nocturnal is longer, of course, but the idea of nocturnal is that you can sleep through it. It’s the only practical way of doing longer dialysis. A person who couldn’t manage to get used to sleeping during nocturnal would probably have to give it up in order to remain sane.
If I had to do hemo 6 days a week for more than 2 hours during waking hours, I think I’d go nuts. In the past, I’ve made some comparisons on here about the results of my daily nocturnal vs short daily. Invariably, someone replies that they get just as good results with their short daily. The only problem is that it’s not a fair comparison because they aren’t actually doing “short daily”, they are doing conventional length treatments on a daily basis. That’s a lot of dialysis. There’s nothing wrong with that in terms of the dialysis itself I suppose, but I have to say, if for some odd reason I was forced to do 3-4 hour treatments daily, I’m sure I would end up on Epoman’s ihatedialysis forum. No offense to you, Epoman
… between you and I, I’m not that fond of dialysis either.
Pierre