Iam 49yrs old and have been on dialysis for 2.5yrs. Just today my dr. tells me he is changing my dialyzer from a frecinius 200 to a 180. IAM A LARGE MAN 6'4" 357LBS and not all fat . My urr is 67 now and spkt/v is 1.42. He is telling me that the smaller dialyzer will "work fine".And aganst my wishes he changed the chart. How can that be ? Please help !And can Frecenius tell him to do this to save money ?

We also recently lowered several people to 180's from 200's. FMC can recommend the dialyzer change but if the doctors see your clearances going lower, they will get you back on the 200s. Trust your doctors- they will do the right thing on this. Did your time also increase? That was part of switching to 180s- the treatment extends for 15 minutes to compensate for the smaller dialyzer. Just remember the doctors don't get paid if you aren't in the clinic, so they want to keep you thriving and doing well.

I am a Nephrology Nurse and am happy to hear that you know your lab values and are questioning changes to your treatment. Great self-advocacy! Your URR/KtV are in a good range yet not excessively high. Question...did they increase your time as they changed dialyzer size? Either way, make sure you track your URR/KtV at next draw date. If it decreases, I would be asking the MD quickly about dialyzer size. If they did increase your time, even by 15 minutes, when they decreased your dialyzer size, I know it can impact your adjustment to dialysis and ability to maximize time out of dialysis. The first person was correct about payment to docs (you need to be there,etc) but I would continue to push the issue of the larger dialyzer if your labs fall to below the recommended targets. From what you describe, there is no reason why you must be changed to smaller dialyzer. Here's a question to ask...What about leaving you on same size (200) and decreasing your time by 15 minutes? I wish you well!

Hi:

I am confused by LEA's reference to the "the first person being correct about payment to docs (you need to be there, etc.) . . . ."

Could you expand, LEA?

And while I don't think anyone - especially a nurse - would want to initiate confrontation, I wonder about jumping to conclusions: "From what your describe, there is no reason why you must be changed to a smaller dialyzer."

A different approach might be to ask for additional information.

I believe in self advocacy, but none of us want to increase suspisions about the intentions of doctors or companies without sound cause.

I look forward to hearing more from br on his experience with the smaller dialyzer.

Best,

Michael

This message has been edited. Last edited by: Michael Williams,

Hey MW,I'm betting they mean "If the patient is not in the clinic but in the hospital on a day the doctor rounds, then he-the doctor- does not get paid to see the patient, because the patient is in the hospital, that would be fraud to bill anyone(medicare,private insurance,etc)" Is this expanded enough?

Hi:

Thanks for the explanation. I didn't make the connection in pw's comment to give doctors at least the benefit of the doubt.

And while I don't think anyone was alluding to fraud, I still look forward to hearing from br on his experience with the smaller dialyzer. Did his readings decline and, if so, did his doctor reconsider? Has his time on dialysis been lengthened?

Your expansion shows the need for this kind of exchange, especially when participants are from different countries, let alone states or provinces.

Thanks,

Michael

This message has been edited. Last edited by: Michael Williams,

Hi, The clarification from "educated guess guy" about Docs not paid if patient isn't in unit was basically what I meant. In no way was I intending fraud nor was I intending for "confrontation" as suggested by MW. In my response I said "from what you describe". Obviously there may be other info re: why size was changed. Yes the patient needs to ask more about it but if no one encourages that , many patients will not ask. That was my point. All patients should be encouraged to ask questions and speak up to understand their care and decisions made by their healthcare team. This (speaking up) is a huge part of National Patient Sfatey goals in the U.S.

HI:

I did not think for a moment you were suggesting fraud. My comment was made regarding terminology.

Asking questions is good in any area, including our health, and no matter where you live.

Thanks,
Michael