How does one know if he is underdialyzed as opposed to not feeling well because something in one’s labs is not in range? How is it decided how long a patient should dialyze?
Right now the simplest way to know if someone is underdialyzed is to look at URR and a patient can calculate this him/herself. To get the URR you subtract the post post from pre BUN and divide that result by the pre BUN. The URR target is a minimum of 65%. Higher is better and usually occurs with longer dialysis. Most people feel better with more dialysis as long as the clinic staff aren’t trying to take off too much fluid because the dry weight estimate is too low.
Example 1:
BUN post = 20
BUN pre = 60
BUN Drop = 40
40/60 = .666 or just slightly above the target floor
Example 2:
BUN post = 15
BUN pre = 60
BUN drop = 45
45/60 = .75 (considerably better)
I’m a little odd about URR as I start with a very low BUN (usually around 40) and end with one around 20, so my URR is low. No matter what Istart with I tend to end with a 20 so I think it is possible that on the NxStage their dialysate/dialyzer doesn’t get you much below 20.
My KT/V however is usually above 2, so I know despite the URR I am getting sufficient dialysis.
Cathy
That’s one of the problems with URR. When someone’s URR is low, the drop can’t be that much. The URR idea (and Kt/V for that matter) came with conventional 3 times a week dialysis. I’m sure it’s not the same with daily dialysis and perhaps something different has to be used to report adequacy like hemodialysis product.
In one of Bill’s posts, he mentiuoned he felt underdialyzed with the time he was prescribed on NxStage. And he said by dialyzing longer, he felt better. Has anyone else experienced feeling underdialyzed? Because I’m wondering how would one know if this was the case- what would it feel like?
It depends what you mean, what are you trying to achieve. The in unit model is all based on adequacy, providing an adequate dose. Then maybe kt/v could tell you whether you’ve reached the floor. Optimal dialysis is harder to measure. When is good, good enough? What makes most sense to me is to start with daily nocturnal and a HDP in the 200s, and if that schedule doesn’t fit then try cutting back to a schedule that does fit your life but I think a couple weeks on daily nocturnal would recalibrate your health measures.
I, for one put very little stock in kt/v. Kt/v may let a unit/dialyzor know if they are achieving a minimum necessary dose of dialysis but I am interested in optimal dialysis. My personal measure of optimal dialysis is when I have a high natural hemoglobin. Through trial and error I have found that a HDP of 100 or greater on the Aksys PHD gives me a natural hemoglobin above 13.
When I feel under dialyzed I don’t have an appetite for one, and I feel like I’ve taken too much Sudafed or maybe had too many espressos. It’s hard to explain but I feel a little foggy or like there is a full body, vague tingling. I also find it harder to sleep even when tired. Of course people with perfectly healthy kidney can have trouble sleeping or feel foggy.
It is hard to sort out what is the cause of what but I have serious doubts about the ability of various blood measures to tell you that you are optimally dialyzed.
With the NxStage it isn’t dialyzing longer as much as using more dialysate. I went from 20 liter of dialysate to 25 liters and felt my appetite improve. When I take two days off in a row or switch to a three day week schedule I feel under dialyzed - those symptoms I listed above. Appetite is a leading indicator.
That Saturday after four days of training on the System One I did not feel like I had dialyzed for over a week in a row (four PHD runs followed by 4 System One runs) I felt like I had taken two days off.
bill wrote:
I, for one put very little stock in kt/v. Kt/v may let a unit/dialyzor know if they are achieving a minimum necessary dose of dialysis but I am interested in optimal dialysis. My personal measure of optimal dialysis is when I have a high natural hemoglobin. Through trial and error I have found that a HDP of 100 or greater on the Aksys PHD gives me a natural hemoglobin above 13.
What is the highest hgb should be? Don’t have time at the moment to read back over posts, but didn’t you say you found that you needed a HDP of about 125 on NxStage to achieve the same level of clearance as PHD at 100- thus you put on an extra bag?
Bill wrote:
When I feel under dialyzed I don’t have an appetite for one, and I feel like I’ve taken too much Sudafed or maybe had too many espressos. It’s hard to explain but I feel a little foggy or like there is a full body, vague tingling. I also find it harder to sleep even when tired. Of course people with perfectly healthy kidney can have trouble sleeping or feel foggy.
Our gentleman friend who is newly on SDD with NxStage says he experiences what you are describing here with the exception that he is now sleeping wonderfully well compared to how he slept at night when on 3x in-center dialysis.
Bill wrote:
With the NxStage it isn’t dialyzing longer as much as using more dialysate. I went from 20 liter of dialysate to 25 liters and felt my appetite improve.
How long did you initially run on your SDD txs with NxStage? When you added a bag how much did the time change? By adding a bag, did your energy also improve or do you mean that you just felt better minus the symptoms you described in the previous post? After you added a bag, did you feel as well as you felt on the PHD?