During the process of troubleshooting drain problems with my previous Liberty Cycler, I had x-rays of my stomach area taken, and read by a radiologist, with the results forwarded to my nephrologist. All pretty standard procedure. In referring these tests to the specialist who initially implanted my catheter for further evaluation and possible repositioning my catheter to help alleviate possible drain obstruction(s), the results were forwarded to this specialist, Dr. Tan in Forth Worth. I am in the process of getting on his schedule for a look-see at my catheter placement. Hopefully this week I will have a date.

As part of this back-and-forth communication between my dialysis team at Fresenius Granbury and Dr. Tan’s office in Fort Worth, my dialysis nurse texted me that they had sent Dr. Tan’s office “a copy of the KUB.” I had never heard of the term “KUB” so I fired up my faithful AI companion, Poe with the results below. Now all of us know what a KUB test regarding dialysis is.

Poe (The Prompt I used is the lead graphic to this post.)

In the context of dialysis patients, a KUB refers to a radiographic imaging procedure called a Kidneys, Ureters, and Bladder X-ray. It is also known as an abdominal X-ray or a plain film of the abdomen.

The purpose of a KUB for dialysis patients is to visualize the kidneys, ureters, and bladder to assess their size, shape, and position. This imaging technique helps healthcare providers evaluate the condition of these organs and detect any abnormalities that may affect dialysis treatment.

During dialysis, the kidneys’ primary function of filtering waste products and excess fluid from the blood is partially or completely impaired. As a result, dialysis machines are used to perform this vital task. However, it is important to monitor the condition of the patient’s kidneys and urinary system to ensure proper functioning and identify any complications.

A KUB X-ray can provide valuable information to healthcare professionals. It can help identify kidney stones, which can hinder the effectiveness of dialysis treatment or cause pain and discomfort. It can also reveal the presence of urinary tract infections, bladder abnormalities, or other issues that may affect dialysis or require additional medical interventions.

By obtaining a clear image of the kidneys, ureters, and bladder, healthcare providers can make informed decisions regarding a patient’s dialysis treatment plan. They can assess the need for additional interventions, such as medication or surgical procedures, to address any identified complications.

It’s important to note that the KUB X-ray is just one diagnostic tool among many used to evaluate dialysis patients. The specific tests and imaging studies recommended may vary depending on the patient’s individual circumstances and the judgment of the healthcare team. It’s always best to consult with healthcare professionals for personalized advice and information regarding a patient’s condition and treatment.

Talk to Assistant on Poe – End

Last week my wife had an appointment with her GP to discuss her hypertension. During the conversation, inter alia, she commented in passing to her GP that I was on peritoneal dialysis. His response was somewhat baffling to me: “You know dialysis does not replace many of the functions of the kidneys.” When my wife related this interface to me, I immediately thought, “What Functions?” In all my training with Fresenius, dialysis research, and discussions with dialysis experts this subject had never been even hinted at let alone broached!

With my research assistant in hand, I wrote the following Prompt with the following results. Please, those on PD or considering PD read on. The AI-provided response sheds light on why my Dialysis Team is so intent on many of the lab results and also on other aspects of PD. By the way, I canceled my subscription to ChatGPT from OpenAI because readily available AI sources are at the forefront. In this instance, I am using my “new” go-to AI assistant, Poe, from Poe.com. I am running the Android App version.

Prompt: A natural kidney performs many functions. Explore the functions that ARE NOT addressed by peritoneal dialysis.

Poe AI Assistant’s Response:

Peritoneal dialysis is a form of renal replacement therapy that helps remove waste products and excess fluid from the body in individuals with kidney failure. While peritoneal dialysis is effective in addressing some aspects of kidney function, there are several functions of the natural kidneys that it does not fully replicate. Here are some functions that are not addressed by peritoneal dialysis:

1. Hormone Production: The kidneys play a crucial role in hormone production. They produce erythropoietin (EPO), which stimulates the production of red blood cells in the bone marrow. Peritoneal dialysis does not produce EPO, so patients may require additional medications or injections to maintain adequate red blood cell production.
2. Vitamin D Activation: The kidneys convert inactive vitamin D into its active form (calcitriol). Active vitamin D is essential for the absorption of calcium and phosphorus from the intestines and the regulation of bone health. In peritoneal dialysis, the kidneys’ ability to activate vitamin D is impaired, leading to the potential for vitamin D deficiency and subsequent bone problems.
3. Acid-Base Balance: The kidneys help regulate the body’s acid-base balance by excreting hydrogen ions and reabsorbing bicarbonate ions. When the kidneys are not functioning properly, acid-base imbalances can occur. Peritoneal dialysis primarily focuses on fluid and waste removal and may not adequately address acid-base imbalances, requiring additional interventions or medications.
4. Electrolyte Regulation: The kidneys play a vital role in maintaining the balance of electrolytes such as sodium, potassium, calcium, and phosphate in the body. Peritoneal dialysis helps remove some electrolytes, but it may not provide the same degree of fine-tuned regulation as healthy kidneys. Frequent monitoring and adjustments in diet or medications may be necessary to maintain proper electrolyte balance.
5. Blood Pressure Regulation: Healthy kidneys help regulate blood pressure by controlling the balance of water and sodium in the body. In peritoneal dialysis, blood pressure management may be more challenging, and patients may require additional medications to control hypertension.
6. Toxin Clearance: While peritoneal dialysis effectively removes waste products from the blood, it may not be as efficient as healthy kidneys in clearing certain toxins. Some toxins, such as certain medications or substances with larger molecular sizes, may not be effectively cleared by peritoneal dialysis alone.

It’s important to note that peritoneal dialysis is a valuable treatment option, and its benefits often outweigh the limitations compared to natural kidney functions. However, patients undergoing peritoneal dialysis may require additional medical interventions and close monitoring to address the functions that are not fully replicated by the therapy.

The most commented-on subject in PD-related forums for those new to the subject is how and where to store all of the supplies required for dialysis. My wife and I shared the same concern, and by lengthy research and discussion decided we needed a home to accommodate dialysis. This resulted in our purchasing a 2500 sq ft home with a layout that apriori seemed to fit. We also considered the proximity of access to DaVita (since left the Granbury area) and Fresenius and VA facilities. The video below is a spartan walkaround of our actual layout to help those in their decisions. Hank

Last Thursday at 1303 FedEx delivered a new/replacement cycler. The replacement is running software version 3.0.03 062; my old cycler was running 2.9.2 062 so we’re on a much newer software version.

So how’s it going so far? The first night, Thursday, no alarms. The second night Friday, slow drain alarms on the first and second drains happening at approximately 1281 and 800+ mL of the accomplished drain. In preparation for Saturday night, I rerouted my patient line so it goes straight across my stomach and to the cycler without any loops being taped to my stomach. No alarms.

I have informed my Dialysis Nurse of the status and inquired about switching to “Treatment Based” as the new manual suggests on page 60. This is still an open item. In order of action, we are going to keep watching alarms given only one night of no alarms with patient line rerouting. We are going to make sure I’m clear of any stool blockage. I may be referred to the doctor who installed my catheter to see if there are any other internal issues blocking the tip of the catheter called “Omental Wrap.” All of this may culminate in a laparoscopic procedure (keyhole surgery) where the surgeon enters my stomach and looks around to ascertain if all is in order.

In the middle of all of this, I was informed initially by Fresenius that the old cycler would be picked up by FedEx on Tuesday, 8/21/2023. Upon receipt of the new cycler, it DID NOT have return labels in the plastic envelope that it was supposed to. This necessitated a call to Fresenius where NOW the FedEx driver is supposed to pick up the old cycler Monday, 8/20/2023, and have a return label with him/her. Seems that Fresenius has a really hard time getting all their ducks in a line!

As I write Friday’s blog it is approaching noon on Thursday and no replacement cycler has arrived nor have we been contacted by anyone from Fresenius. However, I did manage to achieve other housekeeping chores.

We have been trying to move a brokerage account to our main Schwab account with difficulty. Lots of t’s to cross etc. This morning I journeyed to UPS to send a copy of the monthly statement from the account we desire to close to a Schwab rep to process.

The second gate was the delivery of our golf cart. We bought a refurbed 2019 Club Car to putt around Pecan Plantation. Upon testing on our dead-end street, it crapped out and was trailed back to the dealer. Troubleshooting found that a main electrical connection between the battery and generator had battery acid on it and the interior wire had corroded and opened. This prevented charging the battery and supplying power while the engine attempted to run. The wire was replaced as was the battery. We did another test run with good results.

Yesterday was the supply order date for me to order supplies from Fresenius which I did. We will be in Indiana on vacation on the scheduled delivery date at the end of September so I called support and worked with them for an alternative date. We came up with delivery the first week in October so that’s taken care of.

I also made a call to Fresenius customer service to inquire about cassettes with shorter hookup lines. I had previously read that you could order one with a 10-foot instead of a 20-foot catheter line. My thinking is maybe this will help alleviate the drain alarms I have been plagued with for almost a year. I was informed that the cassette with the 10-foot catheter line only comes with a 10-foot drain line which won’t work for me; I need a 20-foot drain line to reach our master bath shower drain. I was also informed that to receive such a cassette my “prescription” had to be altered by my Dialysis Nurse. I could not just order one on my own. The shorter cassettes do not show up in the Fresenius Patient Portal FYI.

In closing, nada concerning the new cycler delivery supposedly scheduled for today.

Called Fresenius “Tech Support” again Monday AM. Seems like my Cycler is going downhill. In the last seven days, I have experienced 13 alarms on the drain cycle. It seems to be developing a pattern of sorts where it drains 12-1400 mL of “distillate”, then hangs. The time on dialysis reflects this in that instead of 10 hours 30 +/- minutes, it jumps up to over eleven hours.

For the record, the support person, after asking expected questions like the cycler’s serial number and software version, was interested in where the system drains (straight into a shower drain), how long a run this is, had the drain line been modified, the data off the cassette (lot #, etc.), and “how long has this been going on? When I responded at least six months it got her attention and even more when I explained my dialysis team and I had exhausted all other possibilities other than the cycler itself and were in unanimous agreement I needed a new cycler.

I’m supposed to receive a phone call that a new unit is en route (haven’t) and receive it within 24 hours. Not holding my breath but praying!