I have been on dialysis for the last 14 months. Earlier, I was on Braun machines and the blood flow rate was never kept more than 300ml/m. Having relocated recently, my new centre uses Bellco machines and reccommends higher blood flow rates of 400-500 ml/min. It does seem to imply more efficient clearance. But I would like to know the pros and cons of moving to such higher blood flow rates. Also, I have a very highly developed fistula. Is there any danger involved due to the increased flow? Please help with any information u have.

As per my understanding, increasing blood flow will increase the kt/v because more blood have been treated. but the problems is you are put heavy work load to your heart. in long term, it is no good for you. Ya, this is one of the way to increase clearance with not addition cost. I would prefer change to a better dialyzer for long term basis.

The higher the kt/v (better clearance) can only benefit you. If your access can handle the higher flow rates and you can get better clearances you are only going to benefit. The strain on the heart in dialysis comes from the removal of fluid and build up around the heart. The stress on the heart due to a increase in blood flow rate is minimum, the heart is not moving this blood the blood pump is. Alot of facilities standard blood flow rate is 400ml/min and above. Usually you run catheter patients at lower flow rates do to the limit of the access.

How do you know when your access and heart can handle an increased blood pump speed? I have a fistula and run at 350. If he blood pump is set for 400 I feel pain in my fistula and pressure on my heart. Can anyone cite an article on this subject and the long term effects?

When you ran at the 300 blood pump speed speed on the Braun, how did you feel pre, during and post treatment? What was our URR and Kt/v?

I am located in India, where these tests are not performed routinely. However, I have been comfortable throughout dialysis at 300ml, as also at 350ml/min. There is no noticeable difference. In fact, feel less tired, post 350ml/min session. I am only concerned about the stress placed on the fistula due to increased rates.

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Originally posted by patient:
When you ran at the 300 blood pump speed speed on the Braun, how did you feel pre, during and post treatment? What was our URR and Kt/v?

The reason I am asking about your txs on the Braun is because I have heard it is an excellant machine which gives a balanced, efficient tx. on a lower blood pump speed like 300-350. Did you feel very well on the Braun? Now that you are on the Bellco machine, do you feel a difference in how you feel?

First of all... the blood flow rate shouldn't affect your heart rate too much unless you're on a cath running on 600 bfr and have hemolosis occuring. For the most part pain in the heart and any other muscle for that matter is caused by the ultrafiltration pulling fluid out of the muscles, or in your case the heart. It is no different than going for a run and getting a cramp. The only thing a higher bfr is doing is giving you a larger bvp (blood volume processed) which in my opinion is only good if you have high flux dialyzers that can handle the flow and still be efficient as far as the actual dialysis is concerned. Also another factor to consider when selecting a bfr is is your dfr. On a conventional dialyzer, theoretically you want your dfr to be twice your bfr. Once you get outside of that ratio your are not getting AS efficient of a treatment. If it is a high flux dialyzer then the recommendation is that the dfr be 1 1/2 times the bfr which would allow for higher bfr's and thus a higher bvp. Make sense? Also, it's really hard to say what machine will give you a better treatment. I haven't worked with Braun myself but I'm assuming it's a worthy device it has passed the rigorous inspections that one would incurr on it's path to becoming a medical device. So I don't believe it's necessarily the machine that gives a good treatment, it's the operator, service technician, doctor, prescription, dialysate and dialyzer. Plain and simple. Machines aren't allowed to slack off. Machines do what they do with little or no error.