The Best Dialysis Machine?

I had an interesting email from Lawrence recently, about the pros and cons of the various brands of dialysis machine:

Hi Greg

I’ve been dialysing for a year now on Fresenius machines and in the last few months have been doing home hemo on a Fresenius.  I’ve had constant issues with poor arterial pressures and alarms. The techies have been out to try and sort the problems and eventually decided that it must be my line which was the problem.  

This week I am on holiday and have been dialysing on a Braun machine.  What a difference!! I’ve been attaining pump speeds of 350 (I can barely make 300 on the Fresenius) and the arterial and venous pressures are brilliant! My KTV is 1.5.  

I communicated this to my unit who have been stonily silent on the subject.  Has anyone else come across this kind of difference?  I’d be interested to know.  The Braun seems a much superior machine to me, with far more streamlined tubing.  I’ve tried to research on the internet but can’t find any comparative studies on dialysis machines.

Best wishes, Lawrence

Hi Lawrence.  I don’t have a lot to contribute about various machines.  I dialyse on Gambro, which are fine.  I regularly achieve a pump speed of 370 milliLitres per minute (mL/min).  Gambro have the usual alarms and hassles, but do the job well for me.

On holidays I have dialysed on Fresenius, Braun and Nipro.  I have found that I don’t usually achieve more than about 350 on the Fresenius machines I use on holidays (through the nurses usually say that the Fresenius doesn’t need to go as fast to do a better job!).  Just the same, all seem fine to me, though technicians I have spoken to tend to rate Nipro a little behind all the others.

I have heard the NxStage machines tend to under dialyse because of their portable nature and use of limited water supply.

Regards, Greg

I look forward to hearing the thoughts from other BigD-ers!

15 thoughts on “The Best Dialysis Machine?

  1. Regarding the NXStage:

    I have been at home with NxStage since beginning of August. The jury is still out – there were some obstacles with the training, resulting in an ER visit, but resolved with the intervention of Fresenius management. Since then, much better. Can’t say for sure if home hemo is better as it is too early in the process. I am sure that extended would be the way to go if I were to need more time to dialysize. Kinda in between right now.
    Will keep ou posted, and feel free to ask me any questions. Nieltje

    Like

  2. My take as a nurse is that the dialysis machine is just a very complex way to deliver blood to the dialyser which is where all the hard work happens. The clearance depends on the speed (how much each minute) of both the blood and dialysate travelling through the dialyser as well as the clearance ability of the dialyser. Some are bigger and move solutes and water much faster.

    When the machine is set for a particular blood flow the more negative the pressure from the arterial needle the less efficient you are at actually achieving what you want the pump to do. ie 350 mls could actually be 325 in reality. Whether the machine alarms depends on where the limits are set usually.

    Usability of a machine is down to the user but some do have more fans than others 🙂

    Like

  3. Hi, Greg!

    I have been on a Bellco on home dialysis for about a year and have had consistently good pump speeds (400) and clearances (1.35 average) but I was recently selected for a trial on the Nx Stage and have been on it for about two months.

    There have been some issues in making the transition, especially the setup and a few technical glitches which the company is addressing, but I’m finding the new machine has some definite benefits. It’s much faster to set up and take-down is a snap: simply remove the cartridge and dispose. No lines to string, no jugs, no complicated disinfection process.

    It’s a slower dialysis but I’m on a two-days-on-one-day-off schedule instead of the Bellco’s Monday-Wednesday-Friday regimen. The result: I feel much better coming off and my potassium levels have dropped considerably.

    It’s still too soon to see how it will work in the long term but so far, so good. And the promise of portability (the portable dialysate bags are awaiting Health Canada approval) is a real bonus.

    Carl Radimer Winnipeg, Manitoba

    Like

  4. Hi Greg
    I am in Australia and I started home dialysis in 1983 with a Gambro AK10. It looked like a lego machine! But that was in the days of the Drake – they looked like old school televisions. Since then I have had a Cobe machine, a Fresenius machine and am now back on a Gambro. I would have to say may favourite has been the Fresenius. It is easy to use and i would say that i felt better when i was on the Fresenius. The Gambro i have now is annoying and i really dont like it. The poor technicians have had to to swap it over for a new machine that many times! I am going to be making the switch back to the Fresenius in the new year. And I really wish I could find a pic of a Drake!!
    Nicole

    Like

    • Hi Nicole
      I am in India and I am a distributor of Medical Goods. I want top take the distribution of Dialysis machines and I was taking advice from Nephrologists for HD machines, Most Drs advise me for Gambro AK98 Dialysis Machine. Then I request to Company to send the details of Gambro AK98 and ask to hospitals who are using it, You can’t believe it that’s a meaning full difference . Gambro AK98 Technology is so far from Fresenius or B.Brown. Even technicians say that Gambro is very easy to handle and most advance in current . Its life is 32000 hrs and it is maintenance free . Fresenius and Brown maintenance is too much and other hand Gambro is full free one.
      Then I take the Distribution of Gambro and I sale more than 1000 machines in my region.

      Like

  5. My husband uses the NxStage System One Cycler at home. He goes at a Blood Flow Rate of 380 (easier on the heart and saves his AV fistula in the long run), for 3.50 hour treatments, 5 nights a week using 30 liters of dialysate produced by the NxStage Pureflow machine, which mixes and produces 60 liters of dialysate from tap water and purified through a NxStage purification system called a “PAK” that we change out once a month. He consistently achieves a Kt/V of over 2.0 (2.75 last month) and because he does more frequent dialysis, his food and fluid intake is not as restricted. His labs always look great, hemoglobin right where it should be, the proof is in the pudding; he’s 57 years old, has Stage 5 ESRD and is diabetic and works a full-time physical job. He’s doing and feeling pretty good.

    Like

    • I meant to add that I think some people, particularly us Americans, look at the NxStage Cycler and think “oh, yippee! Faster and shorter treatments!!” but, from what my husband and I have learned, including reading up on what Australian Nephrologist Dr. John Agar says, it is “time and frequency” that determines whether or not a patient is getting good dialysis. And of course, lab results and how the patient actually is feeling.

      NxStage has come out with an updated cycler that can run dialysate through the dialyzer filter at a faster rate and volume but personally, from what I’ve learned, short little treatments will leave you under-dialyzed. However, if a patient (perhaps due to their size, weight, age, medical conditions, etc..) were to need to use 40-60 liters for their treatments, at least the cycler will let them do that without needing to be hooked for hours upon hours. With that being said, I think more people are doing “extended” or “nocturnal” home treatments at much slower blood flow rates but at higher volumes of dialysate. In other words, nice and slow. That’s probably the best dialysis but for now, my husband and I are staying at the 3.50 treatments 5 nights a week. I am his “care-partner” and do all the setup, monitoring and cleanup. He self-cannulates using the buttonhole method. Total approximate time for setup, treatment, pulling his needles and then cleanup is about 4-5 hours.

      Like

  6. Thanks for that really interesting info Debra. I absolutely agree about time and frequency: it irons our the highs and lows you get with three times a week dialysis, and apart from when you are in the chair, you could well be just another normal healthy person. Of course lots of people don’t get the extended time or nocturnal option because they dialyse at centers that have limited time available. This is one of the strong arguments for home dialysis.

    Great to hear such good things about the NxStage. To date I have always been told that “Its not quite there yet”, but (as usual) its the way you use it that counts.

    Its also great to get to know you and your husband a little better! Cheers! Greg

    Like

  7. I have been using Nxstage for around 3 years and all has been ok until recently when for no reason I am getting a 10 alarm which means that there is air or clotting in Venus line. All are completely baffled as even my nurse was unable to resolve the issue. I am now terrified of having my treatment as have lost about 15 circuits over the past weeks due to this happening. The only difference is that I am now needling in a graft where as before I was using a graft for the V line and a button hole for the A line on a native vein. I would be grateful if anyone has any experience of this happening.

    Like

  8. Have noticed similar differences between machines. Fresenius can’t get more than 250/min( it is used in our hospital), however I use Bellco at home for nocturnal and with it I can easily get 350-370ml/min. It was same with gambro, integra and Nepro machines whenever was on holidays

    Like

    • Noticed the same.

      On Fresenius I hardly get to 250ml/min, when I have to dialyse at centre.

      On Belco which I use at home for home hemodialysis I can get to 300-350ml/min.

      Similar high flow rate was achieved at Gambro when I visited Vancouver.

      Similarly I was able to get to300-350 ml/min when I visited Saskatoon, however, I don’t know which kind of machine they were using. I’m sure it was not Fresenius
      Hope it confirms your observation.
      Mukhtiar

      Like

  9. I’m dialysing for 19 years on various machine with pump speed of 550,
    Now I’m on Fresenius same speed no problem. Your srteri vein must be the problem. I’m from Malaysia

    Like

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s