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!

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.
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 D 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 D Shah said…
I don't honestly feel any different. No challenges moving to this really.
Yogi said…
Sir, are you still using HF Dialyzer? My doctor suggested me FX60 dialyzer and HDF Dialysis on 5008 machine because of high B2m levels and lot of bone pain specially in fingers when I wake up. I have a very poor diet because of weak digestion. Let us know your views please because you are probably using this from a long time.
Kamal D Shah said…
Yes Mr. Yogi, I am still using high flux dialysers. Using high flux dialysers on a 5008 machine will help to bring down beta 2 microglobulinn levels and hopefully help reduce the bone pain. All the best!
Yogi said…
Can this Dialyzer FX60 be used on 4008 machine as well and give good results (not as good as 5008 but like 70% of it). I am asking so because the cost of dialysis on 5008 is double than 4008 for HDF dialysis procedure.
Kamal D Shah said…
Yes, you can use this dialyser in the regular machine. It is difficult to say what % of results it will give. But it will definitely be better than low flux in removing middle molecules.
Unknown said…
Which dialyser is better whether F6 or F8
Kamal D Shah said…
F8 is better than F6.
Anonymous said…
I am taking single use dialyzer in nephroplus dialysis centre. They gave Dora B14-P. Is this F6 dylyzer or F8
Kamal D Shah said…
Somewhere between F6 and F8. Closer to F6 than F8.
Rohan said…
Sir,
Currently which dialyzer are you using? And whether are doing it in home or at any institution.
How is your condition right now if you're saying that you have to do dialysis everyday?
Please tell which dialyzer to be used for new patients on hemodialysis.(currently using niphro 13M (medium flux))
Also what should be ideal dialysis period per week for patient having creatinine level =6.98?


Kamal D Shah said…
Hi Rohan, I am using Fx60 currently. I am doing it at home only. I am doing well. I don't do it 5 times a week because I 'have' to but because I 'choose' to. Doing it every day and for 7.5 hours each time gives me a very good quality of life.

Patients should use the best dialyser they can afford. Try to use high flux dialysers. If not, pick the dialyser with the greatest surface area you can afford.

On dialysis frequency and duration, best to go with the advice of the nephrologist. It is very difficult to say this just based on a creatinine number. I am not even a doctor.

Feel free to ask any more questions you may have.

All the best.

Rohan said…
Sir,
Please suggest some dialyser which should be used and don't make a big dent in the pocket.
Kamal D Shah said…
Hi Rohan, that is a very difficult question. Which dialyser are you using currently? What are you paying for it? Please note that every centre charges different amounts for the same dialyser due to various reasons. But still, I can give some suggestions if you let me know what is the amount you are comfortable spending? "dent in the pocket" is very relative and varies from person to person.
Anonymous said…
nice
Anonymous said…
nice
Anonymous said…
You can compensate the albumin loss by food. Eat egg white. 1 egg white for 20 Kg of your body weight daily. That if your body weight is 70 Kg eat 4 egg whites daily. It is the best and cheapest source of albumin thru food.
Shivam said…
Sir, AVF is very important in MHD. How do you make sure the well being of your AVF. Kindly share some tips. Thanks sir.
Kamal D Shah said…
Hi Shivam, Yes indeed. AVF is very important for MHD. Here are some tips - keep it very clean, wash it with soap and water along with your daily shower / bath, don't allow anyone to take BP or blood samples from that hand, avoid itching.
SR said…
Hi sir,
I saw all your messages. My brother is undergoing dialysis from a month after transplant kidney rejection. He feels very tired after dialysis. Bone pain & finger burning. Which dialyzer do you suggest.
Kamal D Shah said…
Fatigue after dialysis is most likely due to excess fluid removal so your brother should try to decrease fluid intake or increase the number of hours per week of dialysis.

Bone pain could be due to a number of reasons which his nephrologist will explore. Testing Calcium, Phosphorus, iPTH may give some direction.

Finger burning - is it burning or tingling? Many dialysis patients have peripheral neuropathy which can be treated.

The best person to talk about all this would be the treating nephrologist.

Dialyser - the larger the surface area the better, the higher the flux the better.
Neeraj said…
Instead of high flux dialyser reliance ,alternating between Low flux and high flux should bring the balance.
High flux dialyser has few disadvantages.

https://journals.lww.com/jasn/fulltext/2003/12000/effects_of_high_flux_hemodialysis_on_clinical.26.aspx#:~:text=Potential%20disadvantages%20of%20high%2Dflux,transfer%20of%20endotoxins%20(15).
Neeraj said…
From last 5 months using Low flux dialyser F6 has made Phosphatase and Phosphorus levels going high. Until now i have not done high flux and low flux alterations. Looks like need to do it.