One thing about the Fresenius (and I suppose, similar conventional machines where available, but I know nothing about those) is that, because it can do nocturnal (and for this, a machine has to have a heparin pump that can hold enough heparin, and it has to have a dialysate pump that can be set down to 300), it can run a dialysis treatment using only one needle. It’s just a matter of having the right tubing and pump configuration (it needs an extra pump module on the front) and pressing on the single needle “button” on the screen. It’s so easy in fact that you have to check each treatment that you didn’t accidentally choose single needle mode. The treatment is so long that it doesn’t matter. You wouldn’t want to do this unless you really had to, but, it’s a possibility should a person develop fistula problems down the road. I think that this is one reason some dialysis operations like that machine. It has almost no limitations in being able to do everything they might need it to do, including running just about any dialysate concentrate known to mankind, including even acetate. One machine, same maintainers, same parts inventory, same training for everyone (both among nurses and patients)… but mutiple treatment modalities, much flexibility in terms of concentrates, etc.
As far as I know, the original 2008K could not run dialysate at 300, and this is something they added for the specific requirements of my local home dialysis program who were the first to actually have a nocturnal program based on the 2008K.
I’m just mentioning that in passing. It doesn’t mean I’m suggesting everyone should be on the same machine.
Single needle dialysis is not something most of us will ever need, but for those who do, being able to easily do it can mean the difference between continuing at home and having to go in-centre. I know for a fact there are some who do this. My own fistula already has very limited usable needling room left.
Pierre, Our center has patients with grafts use the single needle for nocturnal does yours? I believe they think the less you stick a graft the longer it will last.
I’m not sure about grafts, but I know they have some on single needle. From what I hear, the only disadvantage is that the machine is noisier in single needle mode.
Our center has patients with grafts use the single needle for nocturnal does yours? I believe they think the less you stick a graft the longer it will last.
We hadn’t heard that there are patients on home txs using grafts. Had only heard fistulas or catheters. And this is news to us about this single needle style. Is this in an arm access or are you referring to the lifesite type? We did hear that the new machine, the Allient Sorbent, will only require one needle. Can someone explain how the one needle works?
My fistula is 4 years old almost to the day. It’s an upper arm fistula, and it’s very zig-zaggy, with significant dips. From dialyzing in-centre for 2-1/2 years, due to the usual standard stepladdering style of cannulation, I’ve developed two big aneurysms. You can’t put needles in those, so I’m not left with that much room for needles. Of course, if it ever becomes an issue, in some cases, the fistula can be fixed by surgery. It’s a very powerful fistula with a terrific blood flow, but it’s not that long.
Pierre
Well… I am now home with my new baby. Last nights treatment went great, got off at 11, took out needles and rolled over and went to sleep. “Cleaned” up this am, took about 5 minutes.
Morning b/p and heartrate: tah dah 110/68 and 76, just a bit better than my usual 86/52 and 98-109. Feeling energetic today, and starting shopping for just the right table/cabinet for my machine.
Ordered my rolling travel case, hope it arrives before the 9th so I can use it on our first trip. Taking my 11 year old and a good friend of his to Santa Cruz for the beach and boardwalk. Should do three nights dialysis on the road!!
Numbers still good, fighting phosphorus a bit, but it is also due to a soaring PTH, started Sensipar for that, but doc proabably waited a bit too long to address this issue. Should know if it is still going up or has started back down soon.
Any other questions just ask. I will work on getting a picture when my set up is complete.
Congratulations Cathy, that is great news! You are making history documenting changes moving from one machine to another like the Nxstage so the rest of us around the world can learn from you.
How fantastic to already be working on your first trip with your own machine.
I thought you were on Nocturnal , how is it not sleeping with a washing machine? Must seem strange
:lol:
No beachy, I wasn’t on nocturnal. I am not a good sleeper and just got diagnosed with a type of sleep apnea when my oxygen levels go down too low when sleeping. So, I do daily, 6x a week for around 3 hours a day on the NxStage.
Heather, My descriptions are not the best so I’ll tell you what I know and maybe Pierre can give the technical info. In our program when a patient has a graft it doesn’t matter where the graft is they use the single needle. This requires a pump to be added to the Fresenius Machine. The machine takes the blood out through the needle in the graft stops then puts it back through the same needle. The Allient machine can be used either way. Either Single Needle or Double. It is my understanding the Allient won’t need any machine modification to do a single needle treatment.
I think phosphorus is more than just phosphorus. Phosphorus, calcium, parathyroids and vitamin D (calcitriol for us) all work together. You really want to keep phosphorus under good control. It’s not immediately life threatening like elevated potassium could be, but in the long term, it’s one of the worse effects of renal failure. I know people (especially those on PD who get adequate dialysis in every way except with respect to phosphorus) who end up having to have a parathyroidectomy after less than a year on dialysis. After that, it’s a constant battle keeping this whole system working right.
Pierre
Pierre, I know and do my best. Even my center says it is due to the PTH. My neph refused to prescribe Hecterol or Sensipar and my calcium kept getting high on calcitriol so I would have to stop it. My neph didn’t believe that I had hyperparathyroidism because even though my PTH was above 1000 my alkaline phosphatsse wasn’t high. So, when it finally went high my PTH was about 1600 and he finally prescribed Sensipar, which lowered my calcium enough I could take the Sensipar and Calcitriol, however, in the first couple of weeks my PTH actually went higher, so it is way out of whack right now. IT has been repeated lately and they will probably double my sensipar which hopefully will lower that PTH and everything else will follow.
OMG!! My husband isn’t even on dialysis yet and he has been on Hectorol for months. His Neph has adjusted his dosage twice as he monitored his PTH. Currently he takes one Hectorol every three days.
My neph didn’t believe that I had hyperparathyroidism because even though my PTH was above 1000 my alkaline phosphatsse wasn’t high.
Alkaline phosphatase is not a specific measure to bone disease, and PTH is. Your nephrologist is not following the KDOQI guidelines for bone disease, which state:
GUIDELINE 8B. VITAMIN D THERAPY IN PATIENTS ON DIALYSIS (CKD STAGE 5)
8B.1 Patients treated with hemodialysis or peritoneal dialysis with serum levels of intact PTH levels >300 pg/mL (33.0 pmol/L) should receive an active vitamin D sterol (such as calcitriol, alfacalcidol, paricalcitol, or doxercalciferol; see Table 28 ) to reduce the serum levels of PTH to a target range of 150 to 300 pg/mL (16.5 to 33.0 pmol/L). (EVIDENCE)
8B.1a The intermittent, intravenous administration of calcitriol is more effective than daily oral calcitriol in lowering serum PTH levels. (EVIDENCE)
8B.1b In patients with corrected serum calcium and/or phosphorus levels above the target range (see Guidelines 3 and 6, respectively), a trial of alternative vitamin D analogs, such as paricalcitol or doxercalciferol may be warranted. (OPINION)
Note that the Guidelines do not say “unless the alkaline phosphatase isn’t elevated.” In fact, they don’t even mention alkaline phosphatase. Are you otherwise satisfied with your nephrologist? Because if not, you might want to look for a new one… :shock:
I know, I know. He would order IV hectoral but my center doesn’t allow a home patient to administer IV drugs except for heparin. He did prescribe the calcitriol, but it raised my calcium so I was off it more than on it. My clinic had been trying to get him to write the script for Sensipar but he refused, said it wasn’t covered, but I believe he could have written a special prescription and gotten it covered, but wouldn’t.
I am not wholly satisfied with him, but of the other choices I have I think he is the best. He is slow to get on the bandwagon for newer treatments, but, he did approve me for the home dialysis, being the first patient from my area, so…
That all sounds so good … well, except the PTH but that’s not usually difficult to control. Hope the trip is really fun.