Skipping

For those who do 6x week txs how often do you skip a tx, and when you do, do you dialyze longer the next day?

just once a week, ie six txs a week. Same txs everyday except the one out of seven, hence six txs a week.
???
LSB

I meant, say you do 6 txs a week (skipping just one day), but one week you needed to skip two txs- how would you compensate?

I suspect that most patients would dialyze longer on the day before and/or the day after. Some patients on daily dialysis do dialysis 6 days a week, others dialyze 5 days a week. The frequency probably depends on what their doctor orders, how their lab values are, and how they feel. From what I’ve read, when patients are doing 5 days of dialysis a week, they feel better when they don’t skip two days in a row.

First off, I am on nocturnal txs six days a week eight hour runs. My week starts on sunday and goes till saturday. Because of billing issues I can only take one day a week. Wednesday is the day I normaly take off. So if I took wednesday and thursday off. The next week I would not take wednesday off and run the whole week. I would never do two in a row unless it was an emergency(earthquake out here/ tornado in arkansas/ hurricane in florida/ etc…). I do such long runs there is no need to do a long run or short run before or after. I would not see why it would be needed for anyone though. The prescription calls for what is needed with extra hopefully. So I don’t think anyone would alter their treatments like that. I have cut mine short by changing some values in the middle of treatment. This was necessary to make apointments on time. Shaving a hour off doesn’t seem to harm me. I was only doin six hour runs at one time. The thing about doing long nocturnal runs is not about getting more dialysis for me. It is about running at a slower blood pump speed. This is more gentle on my body. I suspect it is the same idea with anyone running nocturnal…
LSB

I’d be interested to know your pump speed & dialysate flow rate, Leaf’. I only do 4 nights nocturnal, well 3.3/4 really - 3 x 9:15 and 1 x 6-7. Pump speed 250, flow 500. I find sometimes on the 2nd subsequent night (Monday night, after doing 7 on Sunday evening - as happened this week), that I will get low tmp alarms and will eventually have to come off maybe up to 1.5 hours early, as the Fresenius will not run at 0 tmp or below (whereas the Gambro machines will).

Skipping a day or two within one week has and will happen, especially, during very busy important times…so yes, we should dialyze longer and use more dialysate…not sure how many really do but I definately do!

@ bear, My blood pump speed is 250, I use 25ltrs of dialysate at 3.1 per hour, I usually try for 2kg UF that is including .3 rinse back and .3 IPO. My machine sets the flow fraction at 22 and sets the total time at 8:30, but the total treatment time ends up being around eight hours. I use the NxStage machine. I am also using a permacath/quinton that is why I use such long slow treatments. To reduce the stress on the access. I am a bad candidate for more access’s and we have to get the most out of this one for now. I run six days a week for the same time every night. There are days when I get of early, by nudgeing the numbers up some. I never touch the Blood pump speed though. The cath jumps at anything over 300 so I don’t even mess with it. Some weeks things work out so I have to change my days off, but I can only take one day a week. Billing issues. The thing is that I am getting so much more dialysis then I in the past. I could afford a short treatment here and there. I don’t like to play with my body that way, but in the event I have to I can…
LSB

LSB,
Do I understand you correctly that you are doing 8.5 hrs a night on the Nxstage?
How long have you been doing this?
Do you need to take Phos binders?
Are you under 100K?
The reason I ask is that my hubby is on nocturnal and we very much want to test the Nxstage.
Thanks,
Pat

LSB:

am on nocturnal txs six days a week eight hour runs. My week starts on sunday and goes till saturday. Because of billing issues I can only take one day a week

Could you explain what you mean about billing issues, because what if you were not feeling well and could not dialyze or what if you had an important occasion to go to and needed to take off an extra day? Since you are getting plenty of dialysis you could afford to take off, so what does billing have to do with it…never heard this before.

I’d be curious about that too. Facilities don’t want to bill for more treatments than the patient actually does because this could be viewed as fraud. However, if patients turn in treatment sheets to their facility in a timely fashion, the clinic should never bill Medicare or insurance for any day the patient didn’t do dialysis.

@ pat,
Yes I am doing eight hour treatments on the NxStage machine. It calculates 8.5, but actual time is eight hours give or take a few minutes.
I take sensipar and some renagel, but I am addicted to cheese and have been able to eat a few beans. My pho is at 5 since I have been on NxStage which is better then taking binders avoiding cheese and beans and still running pho of 9. I have been using nxStage for three months now. I weigh 70kg’s and am 30 years old. My only problem in the beginning was that there is no reuse with NxStage. Other then that the machine is very good. This is coming from someone who just started home hemo though. So I have no experience on other machines…
@ heather& Beth
Sure I could miss a treatment, but I did not understand that that was the question. I could not make it up though, by not taking my day off the next week. Here is a recent example… I took a monday off cause of a delivery and some work issues. Then on sunday some pro skaters were in town for a skateboard demo and I really wanted to go. So I took sunday off too. Now where the problem lies is that my off days are normaly wednesday. I thought that on monday I was taking that wednesday off early and on sunday I thought I was taking the next wednesday off early as well… Since my weeks go from sunday to sunday, both days off fell in the same week. So the next week I had to take a day off so that the billing would pay for all six days. They will not pay for a seventh day on a week. Frustrating cause I thoguht billing should bo by the month and in my situation it goes by the week…
LSB

Who is paying your dialysis bills? I believe most dialysis providers bill Medicare monthly. However, I have heard that some employer group plans will flag and investigate bills that are over a certain dollar amount. Therefore, to avoid having delays in payment caused by investigations, providers may bill those plans more often – even daily – to keep their bills below the dollar amount that flags the bill. If you’re concerned about having to take off a day you would normally dialyze to keep the number of treatments under 6 in a week, you might want to ask your clinic how you should get the number of treatments you need if you want to take a different day off from your usual day off.

Medi-care pays for the three days a week they will pay for. A research group pays for the other three. I am not concerned about taking days off because of getting the treatment I need. That is not what I said. What I was trying to point out is that because of billing guidelines i can not take two days off one week and then run the whole next week. Meaning I have to be aware of when my billing starts and where it ends in order to get my six days paid for. Sure I could take an extra day off if I need to. My Dr. leaves those decisions up to me. I have been with him for over eight years and he and I don’t talk that much. I am in charge of my care. When I don’t want to do something he doesn’t question me. When I want to do something he will give me his opinion and then support me in my informed choice. I am very luky to have him as a Dr…
LSB