Wednesday, May 23, 2012

An experiment: High flux dialyzers

In India, most people use low flux dialyzers. Low flux dialyzers do not give good clearances of middle molecules. Over time, these middle molecules build up in the body and start causing all kinds of problems. I have been on dialysis for almost 15 years now. I better be careful about these middle molecules!

This has been bothering me for a while now. Though I knew that more frequent, longer duration dialysis is definitely better for me in many respects, I wasn't so sure if it is was good enough when it came to the clearance of the middle molecules.

I started talking about using high flux dialyzers to different people. Many people expressed a concern about the quality of water available for dialysis in India. They said you needed ultrapure water to safely use high flux dialyzers. They said there was a chance of bacteria getting into the blood from the dialysate if the water being used was not ultrapure. There was a point there. I held off for a while.

Recently however, I have been seriously looking at this again and brought this up with my nephrologist. We agreed that it was worth trying out. The worst that could happen was I could get a small reaction of shivering if bacteria did really get into the blood from the dialysate. This could be treated and we could decide to stop.

There was one more problem. The high flux dialyzer was expensive compared to the regular dialyzer I was using. At the same time, I had decided to try out single use of bloodlines as well. Together this would dent another big hole in my pocket! So, we thought we would alternate the regular F6 (low flux) dialyzer with the Hf80s (high flux) dialyzer. Its been a little more than a week of doing this. Things are going good, touch wood!

The plan is to continue this if I do not have any adverse events. The only problem is there is no way to measure if this is doing any good. But common sense and a whole lot of scientific research shows this must be helping!

8 comments:

Anonymous said...

Hi Kamal,
This is very good decision. This will definitely good for removal of ß2-m. And will help in reduce the bone pain. But the other side of this, with the use of Hy-flux dialyzers, higher the albumin loss. Hope you also know this. How are going to manage this albumin? First of all I don’t know that this excess removal of albumin can be compensated by our food intake or will u have to take any supplements for albumin replacement?
One more thing Kamal, polyflux 170H (Gambro make) lesser loss of albumin as compared to HF80S (Fresenius) dialysers. A study says this. So please try to enquire on this subject and Gambro make high flux dialyzers.
All the best Kamal.
BR
Murali

Kamal D Shah said...

No Murali, I was not aware of albumin being lost as well. I will talk to my nephrologist about this and also test the albumin. I will also try and find out about the Nipro dialyzer.

Shravan Vasishth said...

Probably a naive question: How is it that the benefits of high flux cannot be measured? How could researchers decide it was superior if not?

Kamal D Shah said...

Well, Shravan, what I meant is it is not practical enough to measure for me and say for sure that it has benefited. For example, to be sure it has benefited me we would have to know how much of middle molecules it is removing versus how much is being removed by using a low flux dialyzer. Lot of variables could also affect this and in a single person with a limited pocket, it is probably not practical!

Anonymous said...

Hi Kamal,
I agree with what you are saying. There are methods and facilities to test the middle molecule clearance. But I am not sure in India any Lab doing this. Also I doubt, as of now, any one in our country using High flux dialyzers(HFD).
Kamal, don’t worry of knowing the results of middle molecule clearance. This HFD also benefit you in the clearance of Homocysteine which is one of the major considerable causes for CVD, a major cause of patient death. But discuss with the Nephrologist about the albumin loss and Vitamine loss to be little proactive. It is very common that the minerals washout during dialysis even with normal low flux dialyzers. So when you are using HFD, it is better tracking these values in-between so that we are what is happening. So please maintain the records of Albumin, Homocysteine, Folic acid/Folate, Vitamine-B6 and B12.
BR
Murali

Anonymous said...

Are you still on high flux dialysis? What challenges do/did you face while on high flux dialysis?Do you "feel" it is different from the low flux dialysis?
And contrary to what you say, I think we can "measure" how effective it is quite easily.

Kamal Shah said...

Yes, I am on high flux dialysis. In fact, now I do High flux daily. How can you measure how effective it is?

Kamal Shah said...

I don't honestly feel any different. No challenges moving to this really.