Patient info
Joined: 22 Jun 2003
Posts: 2
Posted: Sun Jun 22, 2003 9:01 am Post subject: Treatment change from 3x wkly to Daily
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Kidney International<
>Volume 64 Issue 1 Page 305 - July 2003<
>doi:10.1046/j.1523-1755.2003.00043.x <
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>Change from three times a week on-line hemodiafiltration to short daily on-line hemodiafiltration <
>Francisco Maduell, Victor Navarro, Eduardo Torregrosa, Asunci?n Rius, Fernando Dicenta, Maria Carmen Cruz, and J. Antonio Ferrero <
>Change from three times a week on-line hemodiafiltration to short daily on-line hemodiafiltration.<
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>Background. Daily dialysis has shown excellent clinical results because a higher frequency of dialysis is more physiologic. On-line hemodiafiltration (OL-HDF) is a HDF technique that combines diffusion with high convection in which the dialysis fluid itself is used as a reinfusion solution. The aim of this study was to demonstrate the beneficial effect of the more effective dialysis schedule (daily dialysis) with the dialysis modality that offers the highest uremic toxin removal (on-line HDF).<
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>Methods. Eight patients, six males and two females, on standard 4 to 5 hours three times a week OL-HDF (S-OL-HDF) were switched to daily OL-HDF (D-OL-HDF) 2 to 21/2 hours six times per week. Dialysis parameters were identical during both periods and only frequency and dialysis time of each session were changed. Tolerance, uremic toxin removal, urea kinetics, biochemical and anemia profiles, blood pressure, and left ventricular hypertrophy were evaluated.<
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>Results. D-OL-HDF was well accepted and tolerated. The disappearance of postdialysis fatigue was rapidly reported by patients. Patients mantained the same [time average concentration (TAC) and weekly single-pool Kt/V (spKt/V)] throughout the study. However, equivalent renal urea clearance (EKR), standard Kt/V and weekly urea reduction ratio (URR) were increased during D-OL-HDF. Weekly urea, creatinine, osteocalcin, 2-microglobulin, myoglobin, and prolactin reduction ratios were improved with D-OL-HDF. There was a significant decrease in predialysis plasma levels of urea, creatinine, acid uric, 2-microglobulin and homocysteine over 6 months. Phosphate binders were reduced and antihypertensive drugs were stopped. A 30% regression of left ventricular mass was observed.<
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>Conclusion. The change from S-OL-HDF to D-OL-HDF was well tolerated. Disappearance of postdialysis fatigue, better dialysis adequacy, a higher removal of middle and large molecules, a reduction of phosphate binders, improvement of status nutritional, and an important reduction of cardiovascular risk factors were observed.<
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Dauha
Joined: 22 Jun 2003
Posts: 1
Posted: Sun Jun 22, 2003 9:05 am Post subject: No Kidding
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All I can say is a big Dauha! But now they want to reuse the dialyzers.<
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>YOU WANT TOP HEALTH - DIALZE DIALY ON A F-80<
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>We would out live the BA*****D's.<
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>Forever, sick of it!
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BE
Joined: 23 Jun 2003
Posts: 25
Posted: Mon Jun 23, 2003 7:44 am Post subject: Double Dialyzers
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The treatment discussed here is most likely double dialyzers connected together utilizing a restrictor in the dialysate path. This method ultrafiltrates from the first dialyzer and reinfuses in the second. The increase in convective transport that this provides increases larger molecule clearance. Since phosphorous is larger this would be removed. For this to be cost effective dialyzer reprocessing is common. This has also been done in the US. Also requires ultrapure dialysate. This procedure more closely relates to the physiological kidney with diffusion and readsorption.
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RedheadedReptile
Joined: 09 Mar 2003
Posts: 69
Posted: Mon Jun 23, 2003 11:57 am Post subject: Affect on grafts?
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With daily puncturing, won't the lifespan of grafts be shortened?
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Coil
Joined: 14 Jan 2003
Posts: 27
Posted: Mon Jun 23, 2003 5:21 pm Post subject: OL-HDF
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Hemodiafiltration rarely requires the use of a double dialyzer. The reinfusion they refer to in the abstract involves infusing a sizeable amount of dialysate into the patient and then UF'ing the equal amount out. On-line HDF is extremely rare in north america due to the fact the machine is preparing the solution to be infused, rather than using pre-packaged sterile solution. You can preform it with a IV pump, a scale, and a standard dialysis machine. The big three have the capability to do OL-HDF, they do it routiniely in Europe, however the upgrades needed make the machines too expensize for most clinics/hospitals.<
>P.S. I apologize for the spelling/grammatical mistakes
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BE
Joined: 23 Jun 2003
Posts: 25
Posted: Tue Jun 24, 2003 3:44 am Post subject: Buttonhole
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Daily venipuncture can be done utilizing the buttonhole technique. In this procedure you go into the same hole each time. It is created using standard needles and then using special needles that are not quite as sharp as the standard ones. Of course this only works on a fistula. After checking the procedure stated above does reinfuse dialysate that goes through a filter using a pump. However, the same thing can be done using two dialyzers where the second reinfuses the replacement fluid. And this procedure has been done in the US. In effect the second dialyzer acts like a filter for the reinfused dialysate. And since it is on a volume controlled machine the fluid balance is better controlled.
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one more time
Joined: 24 Jun 2003
Posts: 1
Posted: Tue Jun 24, 2003 9:30 am Post subject: EFFICIENT DIALYSIS
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All of this has already been accomplished using an efficient machine and proper technique in 3x a week dialysis. It has already been thoroughly explained, but not believed. Just letting patients know that they can buy into the daily dialysis and long dialysis if they want to, but it truly is possible to get excellant dialysis in 3 x a week txs. If you want to sit on the chair the extra time it's your choice. REMEMBER--all machines are not alike! If a technician says otherwise, no matter how many years he's been at it, he needs more education. Any technician who is worth his salt knows there is a difference. A good machine (95%) + proper technique (5%) = EFFICIENT DIALYSIS!!! All the extras are just selling points..the extra time for the patient is totally unnecessary!!!!
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sigh
Joined: 24 Jun 2003
Posts: 1
Posted: Tue Jun 24, 2003 11:15 am Post subject: Efficient Dialysis ???
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The reason no one believes it is because no evidence has ever been offered. This is all based on a father?s interpretation of a daughter?s experience. The person advocating this isn?t even the patient it is a father caretaker. Excuse me but the dynamic between a child and their parent caretaker is so complex that it is absurd to base conclusions on the daughter?s report of how she feels to her father.
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Not
Joined: 24 Jun 2003
Posts: 2
Posted: Tue Jun 24, 2003 11:34 am Post subject: To One More Time
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If we only need dialysis 3 times a week on a good machine, then how come the Good Lord gave us 2 kidneys that work 24/7? If your system is so good, then why didn't He just build that into us instead of giving us kidneys?
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>I know that you are a salesman for Braun. Tell me how many dialysis patients out there can afford your machine. Tell me how many companies/units out there are going to throw away their machines just on your say so? Get a life!
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EFFICIENT DIALYSIS
Joined: 24 Jun 2003
Posts: 5
Posted: Tue Jun 24, 2003 6:26 pm Post subject: CHOICE
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Is it so far feteched that a father with a medical background who has fought with all his strength to preserve the life of his daughter could have discovered the key to EFFICIENT DIALYSIS? Who would have a better incentive for this accomplishment, company hired technicians who float from company to company or a patient's own father? <
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>As far as accusing me of being a Braun rep, I have continually denied that I am in anyway associated with Braun. I have also stated that Braun may not be the only machine on the market that can produce stable conductivity. If your company can produce such a machine go for it. Since your machines can not produce stable conductivity, yes, throw them away and stop subjecting patients to poor txs. There are a number of U.S. clinics that are recognizing the merits of Braun, but again I say if you don't want to recognize Braun, build a better machine. Most importantly, give patients CHOICE of the machine. Give them the option to experience which modality works best for their body and which machine works best for their body. And when your equipment can produce what this father has achieved for his daughter in the span of 3x a week dialysis, one successful tx after another in the span of 15 years let us know.
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Coil
Joined: 14 Jan 2003
Posts: 27
Posted: Wed Jun 25, 2003 1:23 am Post subject: Efficent Dialysis
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I realize I'm tilting at windmill's by responding again, however, we have covered this several times before, and as I said the last time you
ought this up, the B Braun is NOT the only machine that can achieve your holy grail of stable conductivity.<
>Unfortunately, again as we covered before, I am not going to get a lesser machine just because one person feels it's the best machine. The FMC and Gam
o salespeople tell me they have the best machines too, however I don't believe them either. <
>The problem is that your decision is based on emotion, rather than logic or any sort of scientific process. And I am not going to give the patients in my unit a lesser treatment based on your feelings. But then I'm just an uneducated tech, who can get any machine to achieve what supposedly only the B Braun can achieve, so what do I know
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Lin
Joined: 28 Oct 2002
Posts: 337
Posted: Wed Jun 25, 2003 2:38 am Post subject: My opinion
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is that just like any other machine or peice of equipment, the more the user knows about it, and the better he/she uses it, the better the outcome will be!<
>I have one favorite tech. who knows all there is to know about both the machine and the txs. and when he is in charge of my tx. I have a wonderfull tx.. problem is, he's perdiem Ugh! Wish I could clone him. I think all the machines are super, in the right hands of course. Just fyi I'm in an FMC unit with their machine. OLC screws with the conductivity and tmp. and uneducated staff tells the pts. "it doesn't make a difference". Lin.
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Bill Peckham
Joined: 06 Jan 2003
Posts: 65
Posted: Wed Jun 25, 2003 6:59 am Post subject: Efficient Dialysis
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I'm with you Coil and I have two additional issues.<
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>First my understanding of conductivity is that, within the normal range, conductivity variations will effect my (the patient) comfort during and after treatment but not my under lying chemistries. Forget what unit techs say if you want ?one more time? but you are also ignoring the published papers of the people who invented the process. One would think that they would understand the process they invented and they are the biggest advocates of more frequent treatments<
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>Second since the daughter has never dialyzed longer or more frequently. How does she know 3x a week on the Braun is better? Better than what?<
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>Coil, going back to the original topic and your earlier post ? Do you have an insight into how the process the paper describes differs from the Aksys PHD? It sounds very similar to me.<
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