Daily Nocturnal Home HDF - 1 Month Update

I switched to Daily Nocturnal Home HDF in the beginning of June. The primary reason was worsening Dialysis-related Amyloidosis (DRA) due to inefficient removal of Beta-2 Microglobulin (Beta2M). There was a concern around such intense dialysis causing the loss of protein and vitamins. The plan was to do a complete set of investigations before switching and then to repeat the entire set a month after the switch to see how things went. 

I did that. Here's what I found.

First, the good news.

There was no decrease in Vitamin B12, Vitamin D, Protein or Albumin. Blood counts and Iron stores all remained fine. Liver Function and electrolytes also remained stable. 

Now, some bad news.

My PTH, which had somewhat stabilised over the last few months found the perfect excuse to garner attention. It crashed. Like it was just waiting for an opportunity. It went to the lowest I have ever had. I stopped my Calcitriol and Cinacalcet immediately and it has started rising again. It should be back up in a few weeks.

However, my nephrologist said HDF should not result in PTH reducing so much. So I am not quite sure yet why this happened.

Now, for the worst news.

My Beta-2m increased. 

Wait...what? Wasn't HDF, that too daily nocturnal HDF, supposed to bring down Beta-2m levels? Wasn't that why I switched in the first place?

The human body is such a mysterious system. You never know what to expect. My nephrologist believes we should wait for at least 2-3 months to conclude. 

I have also read about better dialysers. I currently use an Fx60 dialyser. Some people have suggested switching to Fresenius's Corediax 100 dialyser which is supposed to result in a better clearance of Beta-2m. Some people have suggested changing the lab I use to get my blood tests!

I will have to think through all my options and then take a decision. I will keep you posted.


PRAMOD said…
Hi, So any update?. Why dont you try Baxter High Flux Dialyzers?.
I actually tested with FX80 Dialyzer, not HDF, normal dialysis but with FX80. Wierd thing is my Phosphorous levels are always on the higher side. Dont know why. Should High Flux Dialuyzers reduce it?.

Once i switched to Gambro 17L, my levels are back to normal. Phosphorus is stil bit high but atleast it coming down after switching to Gambro.
Kamal D Shah said…
Hello Pramod ji

I haven't yet tested after that. My doctor asked me to wait for a few months before testing.

High Flux dialysers should reduce Phosphorus levels for sure. I am not quite sure why it not happen in your case.