Guest guest Posted July 24, 2005 Report Share Posted July 24, 2005 Hi , I've heard plenty about the Aksys and NxStage hemodialysis machines. It's hard not to, because both companies are currently waging a fierce marketing battle in order to recover their development costs and become profitable. The Aksys was designed from the ground up to be the most patient-friendly machine available for home hemodialysis. They looked at all the possible ideas, and then they designed a system around them. It's not portable though. Its big advantage (and it IS a huge advantage) is that once the tubing is setup, it can stay on the machine and be reused for up to a month or so. That means much less time spend setup and cleaning up time by the patient before and after each treatment, because it stays setup from one treatment to the next. The downside to this is that in order to do this, the machine has to run another 15 hours a day in addition to the actual treatment time, while it heat disinfects the dialyzer and all the blood tubing so it can be reused in place (this means higher water and power bills, for one thing). It's also a much more complex machine than the typical conventional dialysis machine, and so, it has been plagued by frequent breakdowns. Still, it's a great concept, and they are improving the reliability all the time. The NxStage machine is the portable one. I would say it's actually more a transportable machine than a truly portable one. It weighs about 70lbs, not including the supplies to run it, so it's portable more in the sense that someone can strongarm it into and out of the trunk of a car (assuming it fits). But, it could conceivably be setup in say, a motel room, while travelling, if someone can get it into the room. This is because it does not require connections to a water pipe. Instead, it uses pre-made dialysate which hangs on a pole, like a huge IV bag. In addition, it's designed to be more user-friendly because the whole blood tubing and dialyzer system comes pre-setup in a cartridge that more or less drops in each treatment. The NxStage achieves this portability by limiting what it can do. For example, it's only currently practical for short daily treatments, and it may not be able to adequately dialyze larger people. In order to make it suitable for longer treatments, the company is currently working on making available a conversion kit that adds the capability of connecting to a water supply and thus making its own dialysate on the fly, like a conventional dialysis machine. But of course, that negates any portability advantage, as it makes it the same as any other conventional dialysis machine. At present, both of these machines are suitable for short daily hemodialysis treatments, but not for the much longer nocturnal treatments. Almost all patients doing nocturnal hemodialysis at home in North America use one of two Fresenius dialysis machines, either the older 2008H, or the newer 2008K models. This is because the Fresenius machines have almost no limitations on dialysate flow, blood flow, continuous heparin delivery, time of treatment (easily up to 8 hours for nocturnal treatments). I've so far done both " short daily hemodialysis " at home and " daily nocturnal hemodialysis " , also at home, in addition to having done regular in-centre hemodialysis for going on 3 years prior to that. So, I've done the whole spectrum of possible hemodialysis modalities. I've been using a Fresenius 2008K for both, as well as when I was in-centre. It's not the fact of doing hemo at home that allows one to drink and eat more. If you're doing it at home 3 times per week the same as at a dialysis centre, as some people do, the only advantage is that you don't have to travel to the dialysis centre, plus you can vary the time you go on dialysis more easily than you can change shifts at a dialysis centre. But there's no difference in terms of diet or fluid intake. The eating and drinking advantages come from doing the dialysis more frequently and/or longer. Short daily treatments are better than 3 times per week treatments in that regard, and daily nocturnal treatments are an order of magnitude better than short daily. I like to say that daily nocturnal hemo is almost like not having kidney failure at all, except for the time involved in doing the dialysis treatments. One very interesting and hopeful thing is the ongoing development work being done to shrink the size of the dialyzer itself. The dialyzer is the part of the dialysis machine which actually filters the blood. On my machine, and most others, this is a narrow plastic cylinder about a foot long, and a couple of inches wide. But much smaller ones are in development - about the size of a walkman or a palm pilot. This would make it possible to design smaller dialysis machines, and it would perhaps lead eventually to a small, wearable device. I think that's still some years away though. There is a third potentially portable hemodialysis system just about to come on the market. This one is a re-development of something that was originally available in the late 1970's and into the 80's. It's called the Redy system. Pierre Re: Introduction > > > Yes, he had a biopsy. I¹m struggling with the lab report terms...Would > albumin to creatinine ratio be the same as serum creatinine? Would random > urine total protein be the same as gross proteinuria on the labs? There is > no BUN listed at all. The random urine creatinine progresses over 3 > months > from 70 mg/dl in April to 259 in July. That is off the chart. I don¹t > get > it. > Thanks, Suzanne > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2005 Report Share Posted July 24, 2005 Forgot to add this about PD... It's true that PD tends to cause weight gain. This is because PD removes fluid by having a large concentration of glucose or dextrose in the dialysate. The sugar draws fluid into the dialysate, kind of the same way lactulose relieves constipation by drawing fluid into the intestines. Inevitably, some of it is absorbed by the patient as calories, which causes weight gain (but not the good kind of weight gain, unfortunately). Hemodialysis removes fluid using an entirely different concept, ie. pressure from the blood side of the dialyzer membranes to the dialysate side, which literally forces water through the membrane fibers, after which it's pumped out into the drain. Pierre Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 24, 2005 Report Share Posted July 24, 2005 Pierre, Your discussion reminds me of my first " portable " computer. When we moved out here, I schelped my portable 52 pound 286 (screen was build into the case and te key board folded over it). This portable device wouldn't fit under the seat or in the overhead. Let's just hope the drive to miniaturization for dialysis devices is as fast as it was with computers. Cy Re: Introduction >> >> >> Yes, he had a biopsy. I¹m struggling with the lab report terms...Would >> albumin to creatinine ratio be the same as serum creatinine? Would random >> urine total protein be the same as gross proteinuria on the labs? There >> is >> no BUN listed at all. The random urine creatinine progresses over 3 >> months >> from 70 mg/dl in April to 259 in July. That is off the chart. I don¹t >> get >> it. >> Thanks, Suzanne >> >> >> Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 25, 2005 Report Share Posted July 25, 2005 Hi , I am so happy to hear from you! I often think of you and wonder how you are doing post transplant. Is your new kidney holding up? How are you doing with the post transplant meds? I hope you are doing well. In a message dated 7/24/2005 7:08:04 A.M. Pacific Daylight Time, smustard@... writes: Hello all, This is from about a year back. I have been lurking in the background trying to just keep up. With school and this group, it just became to much email. So I am getting the digests. Anyway, I just wanted to tell Pierre how happy I am with his new dialysis. A friend of ours is doing PD and has gained quit a bit of weight because of the sugar content of the PD fluids. Has anyone heard anything about the new portable Hemo machines? They say that if you do Hemo at home, that you can eat more and drink more. Anyone seen anything about that? Quote Link to comment Share on other sites More sharing options...
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