BE
Joined: 23 Jun 2003
Posts: 25
Posted: Thu Jun 26, 2003 11:53 am Post subject: Dialyzers
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What the above procedure does is use one dialyzer and a hemofilter. The hemofilter basically removes blood plasma. What is removed is replaced with filtered dialysate. It is pumped into the blood tubing.<
><
>You can accomplish the same thing with double dialyzers with a restrictor. This will increase urea clearances and also middle molecules. About as close to efficient dialysis as you can get. And also more like the natural kidney.<
><
>The conductivity mentioned above will not give efficient dialysis. The efficiency of the treatment is dependant on the dialyzer. If you want a real efficient treatment you look for the dialyzer with the highest KOA. Better yet would be two with a high KOA. Besides, conductivity fluctuates on all machines. I do not know who gave him this idea, but I know that you cannot take away a persons rationalizations.
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patient
Joined: 29 Oct 2002
Posts: 137
Posted: Thu Jun 26, 2003 1:11 pm Post subject: dialyzer
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please explain KOA in a dialyzer; does this have any bearing on surface mem
ane?
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BE
Joined: 23 Jun 2003
Posts: 25
Posted: Fri Jun 27, 2003 7:30 am Post subject: KOA
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The formula for KOA is:<
><
>KOA = (Qb/(1-(Qb/Qd)))*LN((1-(K/Qd))/(1-(K/Qb)))<
><
>Where Q is flow rate and K is clearance. B is blood and D is dialysate. What this does is give you one number for the efficiency of the dialyzer. A typical specification sheet for a dialyzer will have many flow rates and clearances. You can take any one of these and figure out the KOA. Higher is more efficient. This allows comparisions for dialyzers that may not be measured at the same flow rates. I have a feeling that when centers go to non reuse the patients get dialyzers with lower KOA's. <
><
>There are many factors that relate to the KOA or efficiency of the dialyzer. Surface area being one. Pore size, mem
ane thickness, and symetry all contribute to KOA.
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EFFICIENT DIALYSIS
Joined: 24 Jun 2003
Posts: 5
Posted: Fri Jul 04, 2003 7:45 am Post subject: More Expensive Dialyzer Myth
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Blood Purif. 2001;19(3):301-7. Related Articles, Links <
> <
>Long-term on-line hemodiafiltration reduces predialysis beta-2-microglobulin levels in chronic hemodialysis patients.<
>Lin CL, Yang CW, Chiang CC, Chang CT, Huang CC.<
>Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan, ROC.<
>BACKGROUND: Hemodiafiltration (HDF) is effective in delaying the surgical need for carpal tunnel syndrome in chronic hemodialysis patients, however, predialysis beta(2)-microglobulin levels were not reduced in most short-term studies. The aim of this study was to assess the effect of long-term and differing frequencies of on-line HDF on serum beta(2)-microglobulin levels in comparison to high-flux hemodialysis (HD). METHODS: One hundred and twelve patients in the Chang Gung Memorial Hospital Dialysis Unit were divided into three groups to receive different frequencies of on-line HDF alternating with high-flux HD. Group 1 was treated once with HDF and twice with high-flux HD per week (n = 21). Group 2 was treated twice with HDF and once with high-flux HD per week (n = 33). Group 3 was treated with HDF three times per week (n = 5 . Analysis was performed to compare the serum beta(2)-microglobulin levels in these groups and to high-flux HD. RESULTS: After receiving HDF for a mean of 7.9 months, group 3 patients had a reduced predialysis beta(2)-microglobulin level (22.2 +/-5.3 vs. 34.8 +/-6.3 mg/l, p < 0.001), postdialysis beta(2)-microglobulin level (6.3 +/- 2.0 vs. 13.8 +/- 6.8 mg/l, p < 0.001) and an increased beta(2)-microglobulin reduction rate (76.1 +/- 5.6 vs. 61.1 +/- 13.3%, p = 0.03) when compared to high-flux HD. A significant improvement in URR (p = 0.0004), Kt/V (p = 0.0002) and TAC urea levels (p = 0.006) but not nPCR (p = 0.122) was found after patients had been treated with on-line HDF. The beta(2)-microglobulin reduction rate was positively correlated with the overall volume of the replacement solution per session (p < 0.0001). Patients in group 3 had lower predialysis beta(2)-microglobulin levels than those in group 1 and group 2 (22.2 +/- 5.3 vs. 25.2 +/- 7.2 vs. 26.0 +/- 4.2 mg/l, p = 0.02). Furthermore, an inverse correlation was found between the predialysis beta(2)-microglobulin level and the duration of HDF, if patients were treated for more than 12 months (p = 0.031). CONCLUSION: On-line HDF has an increased dialysis efficiency compared to high-flux dialysis. Long-term HDF further reduced predialysis beta(2)-microglobulin levels, thus, it may provide an improved modality for renal replacement therapy. Copyright 2001 S. Karger AG, Basel.<
>Publication Types: <
>Clinical Trial<
>Randomized Controlled Trial<
>PMID: 11244190 [PubMed - indexed for MEDLINE<
>
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Paul
Joined: 06 Jul 2003
Posts: 4
Posted: Sun Jul 06, 2003 5:50 am Post subject: high flux
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Flushing using a cheap dialyzer is more effective then using a high flux dialyzer? Then why don't they flush?
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leadsag
Joined: 31 Oct 2002
Posts: 263
Posted: Sun Jul 06, 2003 6:03 am Post subject: reminder
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When looking at study results make sure you look at who funded the study. For example if Amgen is funding a study EPO does amazing things. If Minntech fund a study, renalin and reuse are found to......etc.
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JP
Joined: 16 May 2003
Posts: 4
Posted: Sun Jul 06, 2003 9:50 am Post subject: Its not true
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monrein.free.fr/dialyseoptimale.htm<
><
>Yes Bill, she knows how better is the good tx with a good machine...cause 15 years ago she did txs on many machines for 2 years, but not on her machine...<
>Eating a complete meal starting tx and also use of convection is a lot more efficient than diffusion only. Believe me. Mass transfert is more than 5 liters. <
>Look at the color skin on the photo please...
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Coil
Joined: 14 Jan 2003
Posts: 27
Posted: Sun Jul 06, 2003 2:12 pm Post subject: Efficent
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Is it really accurate to compare something from fifteen years ago? The technology has changed somewhat since then...<
>And as always, I feel it is hard to accept a theory based on one person's experience. It is somehwat akin to basing a prejudice against a country because when you went there fifteen years ao, some one stole your wallet. If I were to say that all Russians (French, Mexican, New Zealender's) are thieves because one of them stole my luggage when I visited Kursk 15 years ago, would people accept my opinion as proof, or would they label me a crackpot bigot?<
>It is similiar to your position. You had a bad experience on Brand X, and a good experience on Brand Y. Therefore Brand Y is superior. Or perhaps the staff using Brand X didn't know what they were doing, and that's the reason behind the bad experience. Your theory is too heavily seasoned with emotion and superstition, to be accepted without evidence. I would suggest getting more people to try several types of equipment, all of the same vintage, as technology changes rapidly. Than you might start getting empirical evidence that people would listen to.
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Johns Caregiver
Joined: 06 Jul 2003
Posts: 1
Posted: Sun Jul 06, 2003 4:48 pm Post
subject: Major Make Machines
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If the big name machines of today are as great as you say, then why does my dh, and most everyone in his unit, stumble out of dialysis or need a wheelchair? Why does my dh struggle so all throughout the treatment (i.e chest tightness, restless leg, dialysis dimentia, inability to stay awake etc) if the big name machines are as advanced as you say? Why does most every patient in my husband's unit stumble with weakness or need a wheelchair after tx? I've seen one after another die after a few years of dialysis. It used to be that I couldn't keep up with my husband - now he can't keep up with me and is going downhill fast. The young woman in the photo looks healthy. That's not what I see when I observe the patients in my husband's unit. The big name machines there don't have anyone feeling well. Everyone's skin looks yellowish grey and all are losing their hair. All look nutritionally starved not at all like the rosy cheeked young woman in the picture.
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Another Author
Joined: 06 Jul 2003
Posts: 1
Posted: Sun Jul 06, 2003 5:11 pm Post subject: Author
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I don't know who you are, but you can get yourself in serious trouble by posting articles in their entirety, if you do not have the Copyright Authorization from the author(s) of the article to do so. While you cite the correct references, there is absolutely no reference to a Copyright Authorization to reprint this article on the Internet. I agree that you probably are a rep of a company, and if so, you probably have this authorization, and you should post it immediately to prevent any legal action that the authors may decide they want to take against you for disseminating their work in a public forum without their permission. There are ways to avoid this, but you should check with your Legal Department to find out how to do this if you plan on posting information about your products on Boards such as this one. You need to do your homework about Copyright Laws before you continue this practice.
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jefelex
Joined: 03 Jul 2003
Posts: 2
Posted: Mon Jul 07, 2003 8:51 am Post subject: Re: machines
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I've been repairing and maintaining dialysis equipment for 13+years now. I've been reading the articles regarding which machine is better than the other - the answer is none. All the machines do is make salt water and pump blood. the dialysis is done by the artificial kidney, and that is where all the attention needs to be paid. Unfortunately, dialyser re-use is a fact of life, but is WRONG WRONG WRONG!!! That is where most of the problems lie, reusing dialysers. No dialyser, no matter what the sales rep says, is designed for re-use. The potting compound that holds the fi
es together is subject to
eakdown at the temperature used for sterilization (if they are steam cleaned) and if they are chemically cleaned, then unmeasurable amounts of sterilant are left in the dialyser with each cleaning. Also, clotted blood particles are left behind in the mem
ane, and although they are your blood cells, they've been obliterated by sanitization agents. I won't put my elaboration here - it'd make you vomit. If you've seen microscopic pictures of new vs re-used dialyser fi
es, then you'll know what I'm talking about. press your clinic to stop re-use, it's bad. I don't work for any dialysis company - I work for a hospital, and I don't have any axe to grind - I'm just trying to tell the truth about re-use!<
><
>John<
>
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Daniel S
Joined: 07 Jul 2003
Posts: 1
Posted: Mon Jul 07, 2003 9:40 am Post subject: a picture is worth a thousand words!
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The young lady looks very healthy for someone who has been on dialysis for 15 yrs. The fact that she's survived on dialysis for that long in the first place shows she's beat the odds. Must be doing something right!
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Hey Webber
Joined: 07 Jul 2003
Posts: 1
Posted: Mon Jul 07, 2003 3:51 pm Post subject: Go back to your site will ya
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Gosh, you go home to your site and quit threatening over here. <
>Some people just dont get it. Gaary go home!
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JP
Joined: 16 May 2003
Posts: 4
Posted: Mon Jul 07, 2003 7:07 pm Post subject: To Daniel
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My daughter has been on dialysis for 17 years. 2 years in center (pict on the left) 15 years at home (pict on the right). I am fighting to get complet independance. I am the only one who care my machines for more 10 years. No more the diktat of the centers for us. We want freedom. But like for Georges Harper it is a big deal...We are expecting for legal advices...Human rights are not respected for the dialysis patients. <
>My daughter has currently the best energy even she is paraplegic due to spina bifida. Never took EPO even 15 years ago when she was in center (EPO didn't exist) with Hg =8. Now she has Hg13.9<
>She is still doing dialysis 3 days a week without pain, weakness, tireless. It is not the case if she does tx with other technology. She doesn't use High Flux dialyzer, only hemophan mem
an...and we don't want to change.
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advocate
Joined: 25 Apr 2003
Posts: 20
Posted: Wed Jul 09, 2003 5:29 am Post subject: Human Rights
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This is the thing that seems to be absent from the dialysis setting. A diabetic has rights to administer his medications, people with other diseases have rights, but if one is on dialysis, he is considered the property of the dialysis unit. Where are the human rights of the dialysis patient to get a quality tx that accomodates his personal choices and needs? <
><
>JP's daughter is getting a hgb of 13.9 without the use of EPO! She has no pain or weakness with her txs and has great energy. What units are producing results like that!! Where would these results go on Dialysis Compare?.. off the charts!!! Give dialysis patients rights and they will get far better results than the units. GIVE DIALYSIS PATIENTS FREEDOM OF CHOICE!!!!!
