Pierre, If I’m using the Nxstage I’ll be doing short txs for six days; wouldn’t I therefore be able to run at lower speeds ect.? Or am I required to run six days a few hrs per day because the machine and/or dialyzer don’t get the same high clearance rates as say the FMC h or k machine? Too, I don’t know if the dialyzer is equivalent; there is a new dialyzer that supposedly get better and higher clearance rates but has not been approved in the states yet. You can read the stats on HDCN.Com. I signed up for their newsletter, which came yesterday with that new info… when I read the stats became quite impressed. HD clearances are already higher especially for nocturnal but with that new dialyzer could be even better and supposedly the amyloid factor is also lessened which is super. Lin.
I understand everyone’s enthusiasm for their own machine, I really do, but I still maintain there’s nothing magic about any individual machine or make of machine. What’s magic is dialysis. The dialysis you get is a function of what’s in your dialysate (calcium, phosphorus, magnesium, potassium, etc.), and how much blood you get through the dialyzer (which itself is a function of how long you run and how fast you run).
The artificial kidney is the dialyzer, not the machine. The machine is just a support for tubing, sensors, pumps, etc. which are needed to get the blood and the dialysate through the dialyzer, and some means of achieving a very precise rate of ultrafiltration (UF is accomplished by transmembrane pressure). Other than the dialyzer which is used, the machine itself is like preferring to drive a Ford over a Chevrolet.
The big choice, in my humble opinion, if both are available, is choosing between short daily and daily nocturnal. If there’s no choice, well, automatically, any form of daily dialysis is better than conventional. If your choice is short daily and the NxStage is available to you, then I see no reason not to choose it. It will save you a bit of setup and cleanup time, and you won’t have to have any plumbing done in your home to accommodate it (as long as you don’t mind storing and hanging the big bags of dialysate, which, correct me if I’m wrong, weigh about 15 lbs). I suppose some people with back problems might not be able to do that, I don’t know.
I agree with Gus though: Go for daily hemodialysis if you can.
Pierre
Hi Lin
I get into trouble here everytime I talk about short daily vs daily nocturnal, because I use the commonly understood definition of “short” daily, which is 2 to 2.5 hours, maybe 3, 6 days per week. There’s an old saying that goes something like this: “If you want to speak with me, define your terms”. 
Some can do longer if they want, but then it’s getting a little away from the concept of short daily - which is to get the same total hours of dialysis in a week as you do with conventional hemo 3 times per week. If we assume those treatment times, to get adequate dialysis, you have to be running your blood pump and dialysate pump speeds at about the same speeds used in conventional hemo 3 times per week (for me, when I was doing short daily, it was 2 hours 6 days per week, running the dialysate at 500 and the blood pump at least at 400). If you run it slower, you will be getting less blood through the dialyzer each treatment. The concept of short daily is that you run the same total time per week as you would in conventional hemo, except that you spread it out over 6 days rather than just 3. This gets you the advantage of getting those first most efficient 2 hours of dialysis 6 times per week instead of just three, and also, you don’t have as much time to gain fluid in between treatments.
Given a fixed amount of time, each time you run your blood slower, you get less dialysis. In the very long nocturnal treatments, it makes little difference. But, it makes a big difference in short daily treatments.
New dialyzers are interesting, but this is no different than when more porous high flux dialyzers came along in the 1980’s, at which time it became possible to get “adequate” dialysis in 4 hours whereas with the low flux dialyzers of before, you had to sit there for 8 hours or more per treatment. Just taking out toxins faster is not the whole story, as we have found since then. Even if they can be removed faster by the dialyzer, it doesn’t mean that these products can shift to your bloodstream as fast.
If ultimately you want to do short daily only times per week, then, you either have to increase your blood pump speed (assuming your heart can take it), or you have to increase your treatment time. For example, in my program, we first train and then do short daily for a while. During the training short dailies, because I didn’t go in on Saturdays, my treatments were 2:20 per day, 5 days. Then when I went home, they shortened to only 2 hours. In both cases, this is because it had to equal 12 hours per week. When I converted to daily nocturnal, my treatments became 6 to 8 hours, running the blood pump at 300 or less, and the dialysate pump at only 300. Many people don’t seem to realize that the speed you pump your blood at is a factor in how much dialysis you get, given the same treatment duration.
Pierre