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Predicting Kidney Failure

January 13, 2023 / Henry Feeser / 0 Comments

From my history you may correctly ascertain that I spent many years on the edge of a cliff concerning when the kidney failure shoe would drop. I knew firsthand from my lab reports that my eGFR numbers were going the wrong way in conjunction with creatinine values steadily increasing. But to what extent, what timeframe, when would I have to go on dialysis as a result of complete kidney failure? Being an engineer and a Purdue Krannert School of Managment PhD I wanted numbers, probabilities, etc. No doctor even came close to a WAG (Wild-ass Guess) let alone a statement like “The probability is 0.62 that you will not require dialysis for at least five years.) I was just told that there is no cure and it’s only going to get worse.

This blog will fix this gap for readers willing to gather some common lab numbers and click boxes on a website or iPhone/Android app. You will be empowered to calculate what I just laid out above on your own, and to play “what-ifs” with creatinine and other lab variables. For example, how high does my creatinine have to increase to put me in a high-risk category for dialysis? Rather than the current state of worry because your creatinine readings are going south placing you in a static kidney failure category without any indication of timing of pending failure, you will know where the cliff’s edge is. And failure is pending; kidney failure WILL happen if you live long enough to ring the bell. Trust me, I arrived there after thirty years of being under the gun or being on cliff’s edge.

There is a web site named MedCalc that provides free access to hundreds of medical -related calculations. The one of interest herein is by a MD/PhD by the name of Navdeep Tangri and is named

Kidney Failure Risk Calculator

It predicts progression to kidney failure in patients with chronic kidney disease (CKD) and is located at this link. It requires inputting the following information: eGFR, sex, urine albumin-to-creatinine ratio, age in years, albumin, phosphorus, bicarbonate, and calcium. These values are common to labs reports for those with failing kidneys. The output provides an estimate of your five-year risk of experiencing kidney failure. The embedded screenshot below is my result.

Since I am already on dialysis after experiencing greatly diminished kidney functioning, we would expect the dire results thus obtained. Try the algorithm. You might be enlightened.

Grim Reaper & Dialysis

January 12, 2023 / Henry Feeser / 0 Comments

It is normal human nature to raise the question, “Now that I am on dialysis, how does this alter my lifespan?” For me at 84, I have three choices: Dialysis, Heart Transplant, or death. That simple. I chose not to pursue a transplant for one main reason – at my age younger people have much more to gain and potentially give back to society than I have so I defer to them. While I have ruled out a transplant, that does not mean I still can’t give a little back to society, this blog being an example. So it boiled down to Dialysis for me.

But this still begs the question, how has and is dialysis impacting my lifespan, or how much longer statically I will live. In 2018, adjusted mortality was more than twice as high among Medicare beneficiaries ages 66 years or older with CKD (96.0 per 1,000) compared with those without CKD (41.0 per 1,000). According to data from the U.S. Renal Data System, the chart below follows:

70- to 74-year-olds on dialysis live 3.6 years on average, compared with 12.2 years for their healthy peers;
75- to 79-year-olds on dialysis live 3.1 years on average, compared to 9.2 years;
80- to 85-year-olds on dialysis live 2.5 years on average, compared to 6.7 years; and
Patients on dialysis ages 85 and up live two years on average, compared to 3.5 years for their healthy peers.

A check on the above is provided by the SSA with a web site in which sex and date of birth are entered to ascertain how numbered your days are. Mine is shown below from their site:

In researching background for this blog, I discovered that there is no simple answer to the question of how dialysis impacts life span. There are so many what is called in statistics “intervening variables” as to defy meaningful computation. A few of these variables are sex, confounding health conditions (approaching unique for each individual), ethnicity, race, age, age upon onset of dialysis, mental approach to dialysis, etc.

However, I did discover research from a group in Canada shown below that provides some interesting data. I fall in the last row of the bottom chart. Obviously being a diabetic AND on Dialysis loaded heavily in their predictive modeling. The last bottom row suggests I have a 4.1% chance of living 10 years after starting dialysis. I’ll take the odds.

Bottom line: All of us have a need to be exceptional, don’t we?

Storage Hint

January 11, 2023 / Henry Feeser / 0 Comments

Today being Wednesday, it was time to restock our Ready Service Locker (RSL) with a week’s worth of Cycler supplies. Specifically, 5L dextrose bags, 3 L 1.5 % bags, 2.5 % 3 L bags, and cassettes for the following seven days. We moved the associated boxes and gear from our monthly storage unit in the spare bedroom to the Cycler area.

When your start to open the boxes containing the dextrose fluid for the Cycler, you will notice a large warning not to use a box cutter to open the box.

The short video embedded below shows you how to open the boxes without any possibility of damage to the contents.

Safely Opening Boxes

After opening the boxes, they are unloaded into the four bottom right divisions as shown in the last picture below, with the heavier 5 L bags in the bottom two divisions, and the lighter 1.5 and 2.5 gabs in the upper two divisions. We have moved the cassettes to the shelf under the Cycler so that they don’t have to be bent 180 degrees for storage.

Power Backup Dialysis Cycler

January 10, 2023 / Henry Feeser / 0 Comments

I have seen various takes on the requirements to provision backup power for the Dialysis Cycler (and most of it out in left field.) The purpose of this blog post is to provide my input to this concept (BS/MSEE Purdue University.) The image below from the Cycler Manual shows the max power at USA’s nominal 115vac public power to be 480 watts. Keep in mind that this is MAXIMUM.

What does it take to feed a 480-watt load for say 11 hours (my Cycler times have been in general between 10 hours 25 minutes and 10 hours 50 minutes?) In this case, I am going to address battery backup in the form of a UPS (Uninterruptable Power Supply.) We need to feed a 480 watt load with nominally 115 vac for 11 hours. These are our parameters for calculating the number of and Amp-Hour requirements for batteries for our UPS, as well as the Invertor to invert 12 volt direct current from the battery(ies) to 115 vac.

Luckily for us, there are several USP Calculators available on the web. I have linked the one we will be using. We have to use iteration (try values until desired results are obtained) in the panel.

In the UPS panel, I inputted our power of 480 watts, available battery amp-hours of 200, and number of 200 amp-hour batteries at 3 to obtain the 11 hours 32 minutes runtime which would cover our requirements. From this we have calculated that we require three, 12-volt 200 amp-hour batteries. Turning to our universal off the shelf place, Amazon, we find that Renogy makes such a battery for $359.99 each, or about $1180.00 for the three.

The inverter of at least 600-watt capacity is also sourced from Amazon. A 600-Watt Pure Sine Wave Inverter goes for $78.70.

We need one more component to kluge together a UPS for our Cycler, a trickle charger to keep the batteries up. Amazon has one of these fitting the bill (10-Amp Car Battery Charger, 12V and 24V Smart Fully Automatic Battery Charger Maintainer Trickle Charger w/ Temperature Compensation for Car Truck Motorcycle Lawn Mower Boat Marine Lead Acid Batteries) for less than $27.00.

So, for $1180 + $79 + 27 = $1286 plus tax etc. you can build a healthy UPS that will run your Cycler for a complete Dialysis. You will also have to provide some battery interconnecting cables. Or you can buy a small gas generator such as a Honda 1000, or a new Ford truck with EV and plug into it, or……? You are in “charge.”

New Cycler Alarm

January 10, 2023 / Henry Feeser / 0 Comments

I have been on Dialysis using the Fresenius Liberty Cycler for over three months. Last night was just another night, until. Until after hooking up to the Cycler per usual and going to bed, the Cycler screamed at me with a blaring alarm with its “Stop” button flashing. Thought what the hell now?

While my wife broke out the manual in an attempt to ascertain what was going on, I checked every obvious possible conflict point of origin to no avail. See chart from manual below. Yes, I triple-checked everything and even installed new 5000 ml and 3000 ml dextrose bags. Still throwing “Slow Fill” warning.

Bottom line, the procedure could not go on, we had no fault codes to indicate what was happening, other than a screen display “Slow Fill” and alarms. Having been through the song and dance with tech support before – you have to spend an inordinate amount of time filling them in on the boiler plate of your setup before resolution is even attempted (which to a degree I understand), I shut the Cycler down, went through the lost power sequence at boot up, and effected a startup as if from scratch with new bags and new cassette.

This fixed things for me, and I was able to get some sleep after over an hour of wrestling with the “Slow fill” alarm. What caused it? Who knows, maybe the bugs of Cycler Past?

Last Component of our Dialysis Setup: Master Bath

January 9, 2023 / Henry Feeser / 0 Comments

Our Master Bath is used in two instances in support of my PD treatment. First is to undress and dress my catheter area before and after showering; the second is to cleanse my hands prior to making ready to hook up to the cycler at night. The following items are positioned on or in the sink area of the Master Bath:

Health Guard Antibacterial Hank Soap
ExSept Antimicrobal Exit Site Skin & Wound Cleaner
Gentamicin Sulfate Cream by Perrigo
Paper Towel
2×2 gauze pads
Band-Aid Small 2×2 padded gauze pad
Q-tip
1-minute Timer (to time evening handwashing)
Tape
Lanyard

The following embedded video depicts use of the above itmes:

In & Out Showering with Dialysis Gear

My PD Setup: Standalone Workstation + Ready Service Locker

January 7, 2023 / Henry Feeser / 1 Comment

This bog entry addresses two aspects of our PD setup; what in the Navy is referred to as a “Ready Service Locker (RSL),” an area in which supplies that are to be used shortly and/or daily are stored usually in close proximity to where their end use takes place, and secondly, an added combination table/storage area that is used daily in preparation for hooking up to the Cycler.

First our RSL: We have adjacent to the Cycler and the Cycler prep area an Armoire in which we typically store linens. It has six divided sections in the top half which nicely house a week’s supply of 5L and 3L dextrose bags, and cassettes for the Cycler. As part of my morning disconnect from the Cycler, I breakout new dextrose bags and a new cassette and place on the Cycler for that night’s use. I don’t open the cassette plastic bag until evening when I set up the Cycler for that

Armoire

night’s run. See left picture. In the picture to right you can see the supplies in the bottom four sections of our armoire. Once a week, usually on Wednesday, our recycling day, I break out 3 or 4 boxes of 5L, one box of 3L 1.5 %, and one box of 3L 2.5 % solution along with seven cassettes and load the RSL. I have to fold the cassettes to get them into the armoire so I can close the doors which does not harm them in any way.

Combination Work and Storage Area adjacent to our armoire TSL and Cycler:

We have a white cabinet from Wayfair that was originally intended to be used in a kitchen that has a natural wood-finish top, two drawers, a storage area to the top left and a paper towel holder to the right, four doors in the front and one shelf therein. I use the top area every night, twice, once to break out supplies to use to clean and administer to my stomach catheter after showering, and once to prepare to hook up to the Cycler at night.

The following will be detail-laden but is of upmost importance to those embarking on a dialysis journey – you have to have ready access to needed and/or required components of the treatment. For ready access on the top of the work area I have:

Face masks
Aniosgel Hand Sanitizing Gel Hands Rub (Used after a medical 2-minute wash of hands)
Alcaris 50 Disinfectant (used to disinfectant Cycler attachments)
A 2-minute timer (disinfecting Cycler attachments)
Storage for Q-tips and 2×2 gauze pads (Used to clean catheter area and Cycler attachments)
Plastic clothes pin (Used to hold 2×2 pads soaked in Alcaris on Cycler connection for 2-minutes)
Sanin cloth Bleach Wipes (Used to clean all work surfaces, Cycler and Cycler stand)
Paper towels (Used to clean and dry surfaces)
LED light (Used to enable viewing of work surface at night before bed)
Daily log sheet (Used to scribe and transcribe required biometric data to Cycler after treatment)
Paper tape (Used to secure tubing to stomach after hooking up to the Cycler)

Stored in the cabinets I have:

stay*safe caps (One used each day to seal off catheter upon disconnection from Cycler)
Dental towels (Used to prevent bleach from bleaching clothes)
Blood pressure apparatus
Heater blanket (Used to heat Dextrose bags for manual dialysis)
Gentamlcin Cream (Used on catheter-stomach access every night after showering)
13-Gal kitchen trash bags (used to dispose of all dialysis waste products)
Extra paper towels
Kleenex
Backup/clean tubing lanyard (discussed in a subsequent blog)
Band-Aid 2×2 small, padded gauze pads (Used after shower to dress catheter access)
Alcohol prep pads (clean tubing etc)
3M Micropore paper tape (Used for catheter dressing and tubing restraints)
Ready Locker 2×2 pads (used after showering for catheter access dressing and pre-cycler tubing fitting sterilizing)

The next bog entry will address the area in our Master Bath used to prepare for showering, post shower catheter administrations, and pre-cycler hookup prep.

My PD Setup – Storage of Supplies

January 6, 2023 / Henry Feeser / 1 Comment

There are literally hundreds of pounds of supplies associated with PD. The majority are provided by

Storage

Fresenius and a few out-of-pocket by me by my own volition (subject of a future blog). Let’s start with the largest, bulkiest items, the solution boxes. As stated in the last blog post, I am on 8L of PD solution which consists of one 5L bag and one 3L bag per day for 8L total. Fresenius ships the 5L solution two to a box, so a month’s supply (30 days) is 15 boxes. The 3L bags come four to a box, so 30 days’ supply requires 30/4 or 7 1/2 boxes. Cassettes (provide all the plastic lines and special fitting required to interface with the Cycler) come 10 to a box, so a 30-day supply is three boxes. Add all of this up and we have about 26 boxes just for a month. If you add in another 10 days for backup, you have on the order of 35 boxes steady state just for ongoing needs. Our storage schema is shown in the picture which is in our spare bedroom closet. We order supplies on a monthly basis. CAVEAT: The initial solution mixture provided by Fresenius contained much too much 2.5 solution and is not returnable to them. Try to ensure that your initial solution shipment matches what your doctor is recommending for you to start with!.

However, at least at the beginning of PD, things are not steady state. Early on and continuing until today, I experienced EDEMA in my ankles (Puffiness caused by excess fluid trapped in my tissues.) To assist my body in properly disposing of this fluid via PD, my Clinical Nurse and erstwhile guardian (part of the Fresenius-provided team and a Godsend) Cindy suggested upping the strength of the dialysis fluid, called DIALYSATE. (The Components of PD which directly impact efficacy of the PD and can be manipulated to maximize solute and fluid removal are dialysate volume, dwell time, number of exchanges per day and potency of the dialysate itself.) There are three “strengths” of dialysate, 1.5 (yellow), 2.5 (green) and 4.25 (red) where the numbers indicate percentage of dextrose (yes sugar for diabetics reading this) in the solution. I started off on all yellow/1.5. To combat edema, we moved up to 3L of 2.5/green on MWF which to date has at least moderated my ankle swelling. Thus, I have had to juggle types of 3L boxes to accommodate my 1.5 and 2.5 requirements. Same number of boxes but different logistics.

The next blog will address the third leg of our PD effort, the stand-alone workstation.

My PD Setup:

January 6, 2023 / Henry Feeser / 0 Comments

My PD setup consists of four stations:

The Liberty Cycler located adjacent to our bed pictured herein;
A storage area in a spare bedroom closet;
A separate workstation and storage area in our Master Bedroom;
And lastly, a work area in the Master Bath for aseptically cleaning and dressing my catheter access region.

Liberty Cycler

Introduction:

January 5, 2023 / Henry Feeser / 0 Comments

Welcome to my blog which is dedicated to sharing my personal experience in traveling the road from a healthy US Naval Officer to a Home Dialysis patient.

Background: From December 1971 to October 1972, I served In-Country Vietnam as a USN Naval Advisor to South Vietnam’s Brown Water Navy. As such I traveled extensively throughout Central and South Vietnam’s riverine areas where I was subjected to exposure to Agent Orange. Subsequently I developed Type 2 diabetes which I first was able to control with diet and exercise, then oral medication, and finally insulin. This took place over about a thirty-year timeframe. In the early nineties my GP at the time observed that my eGFR (estimated glomerular filtration rate, a measure of how well the kidneys are functioning) was on a downward trend (not good) and passed through the 60-threshold level indicating pending kidney failure. Some 28 years later, my eGFR reached the 6 level, I felt like crap, and suggested to my Renal Specialist Dr Turner that it was time to move on to dialysis to which she agreed.

On 8/20/22 I started Hemodialysis with Fresenius Granbury, TX which lasted until 9/24/22. On 9/26/22 I started training at Fresenius for PD (Automated Peritoneal Dialysis also known as CCPD, or continuous cycler-assisted Peritoneal Dialysis) and on 9/30/22 accomplished my first at home PD treatment and have been doing so every night since.

I am an engineer (see www.feeser.net for more details on my background) and as such, have been “engineering” small tweaks and making observations concerning the entire PD process. It is the purpose of this blog to document and pass on to those just starting or already on the same path as I am traveling perhaps to lighten the load for some, to share like experiences with others, and just inform others as to what PD is all about.

Henry Feeser's Peritoneal Dialysis (PD) journey