posted from another board, www.kidneypatientguide.co.uk
Hi,
What I would like to know, does a higher pump speeds change the lifespan of a fistula. I’m currently running at 350 and thinking of 400.
Is the gain of the clearence worth it?
Thanks
Alasdair
surely theres more to dialysis then that, the dialyser & dialysate for starters??
J who runs at 350 usually over 3 & a half hours. is that extra 50ml/min any good or for a fistula?
I think that really depends on your fistula, for example…I have my fistula since 1984 and for many years incenter I never had it high…early years for about 275 -300…
Currently, I now can tolerate higher speeds…the highest I’ve tried is 450, but most of the time I have it set to 430…
If your fistula has excellent transonic results, working quite strong then you can go higher…but do it slowly, not a BIG leap like from 350 to 400…slowly find out how faster you can handle…one day 360, another day 370, another day 380…till you get to the highest…I’d not recommend over 450 within 3 hours…
My trainers on Nxstage wanted me to run at 480 but I just run at 450 It only ads like 10 to 15 minutes to my overall time. At 480 the line really jumps. I can tolerate 480 but I don’t feel it’s necessary.
The article was titled “Fistula First” Is it time to curb our enthusiasm?
Parts of the article: I am quoting Dr. Richard Maerling here. "So as not to be branded a heretic, let me start by stating the AVF is the preferred access in most patients. But in our pursuit of more fistula use, let us not lose the perspective that an AVF is a nonphysiologic anomaly and is certainly not desireable and of itself. It is the lesser of 3 evils. The drive to increase fistula use may lead to unintended consequences related to the negatiave hemodynamic effects of the fistula across larger populations.
ALL AVF’s as well as PTFE grafts cause increases in the cardiac output that vary with the size of the access. Radiocephalic AVFs generally have flows under 1 liter/min while brachiocephalic AVFs have flows closer to liters/min. The use of the latter is on the increase. While the upper arm AVF is generally considered to be safe, there is little evidence to support this notion. It is clar that adding 1.5-2 liters to the resting cardiac output is not benign; cardiovascular complications can develop. Whether taking the form of overt high output heart failure ( a condition that is undoubtedly
under diagnosed) or slow progressive dilated cardiomyopathy, the impact of the AVF could ultimately be fatal. The exact contribution of the AVF to overall cardiovascular mortality in dialysis patients is UNKNOWN.
The AVF unlike the PTFE graft, tens to become hypertrophied and dilated over time, which can significantly increase the flow rate. This is often
accompanied by cardiac chamber dilation, volume expansion, and greater
preload dependence. Inability to remove fluid during dialysis might indicate incipient high output failure. Cardiopulmonary recirculation will also increase with fistula flow rate and actually limit dialysis efficiency.
The experience with nocturnal hemodialysis in Canada has been excellent, inspite of catheter use among these patients. (they did replace 1 catheter every 8.4 patient months). Canadian hemodialysis patients use catheters at twice the rate of the U.S. hemodialysis population but have a LOWER OVERALL PATIENT MORTALITY. Efforts aimed at reducing catheter-related infections would undoubtedly improve outcomes, much as they did in peritoneal dialysis where peritonitis rates among U.S. patients had dropped from one in every 8 months to one in every 36 months. These efforts may be neglected in the current climate.
I don’t know if this article answers your particular question in that I don’t know if the Blood Pump Speed affects the flow of the fistula or the fistula has the flow which affects the blood pump speed. But if higher flows tend to incrased the dilatation over time I would think this should be considered.
I am only giving you the information in the article. I am not in anyway intelligent enough to think that my intrepretation of what I read is even right. But this may be a place to start with the question you have if you want to talk it over with your doctor.
Hi y’all,
This is just slightly off-topic, but since a couple of folks have posted on or about articles in Nephrology News & Issues, I wanted to remind everyone that patients can get a half-price ($27.50/year) subscription.
Here is the subscription page link: http://www.nephronline.com/core/newsubscription.phtml.