Daily Nocturnal Home HDF - Three month update

I completed 3 months of Daily Nocturnal Home Hemodiafiltration (HDF) recently. When I started, the primary reason was the building up of Beta-2 Microglobulin (Beta-2m) in my body and causing Dialysis-related Amyloidosis because of which I had bad shoulder pain on the nights of dialysis. After a month I got all the blood tests done and while most other things were fine, the Beta-2m had actually nudged up a bit instead of falling. Further the iPTH had crashed.

I stopped taking Cinacalcet immediately. I got my blood tests done recently and found that that took care of the iPTH which currently is at a healthy 308 pg/ml (remember the normal iPTH level for dialysis patients is between 2 and 9 times the upper limit of the lab's normal range).

The Beta-2m was what I was most concerned about and that finally reduced. Well, not a whole lot but at least the trajectory is right, now. It was around 20,000 ng/ml before HDF, 23,000 after a month of HDF and is now about 19,000 ng/ml.

I made two changes to my treatment parameters about a month and a half back. I switched to a Fx100 Corediax dialyser from Fresenius and I also increased my Blood Flow Rate from 250 ml/min to 300 ml/min. The Fx100 Corediax is supposed to be a monster at removing Beta-2m. And convective transport which is the clearance modality in HDF does require slightly higher blood flows. While I have been told that in HDF, the infusion volume is the main thing, I had to experiment a little to see what I could do to get the deadly Beta-2m out of my body.

I have been toying with reducing my HDF to 3 out of the 5 treatments per week that I do and do regular HD the remaining 2 days. I couldn't find any literature to support daily nocturnal HDF. I found only folks who were doing short daily or thrice weekly nocturnal. It is disconcerting to be doing something new which does not have any evidence to back it.

On the other hand, will reducing the frequency impair removal of Beta-2m? 

So I am torn right now and need to take a call. I will keep you updated.


Ushabalu said…
Dearest Kamal
As always you amaze with the meticulous way of analyzing your issues..God bless !! God bless !! ☺️💜
Kamal D Shah said…
Thanks so much ma'am!