Tag: alarms (Page 15 of 43)

I previously blogged about Metyos, the Paris, France-based company developing a wear-on device much like the Libre 3 to aid in detecting CKF earlier. In researching the company, I dropped down on their website and filled out a brief questionnaire indicating that I would participate in developing their new product. In a follow-up, I filled out a detailed history-based questionnaire, followed by an invitation to participate in a video conservation with a Metyos rep. That conservation took place this past Friday and was with the CEO/Cofounder, Alexandre Boulanger – lead picture.

The start of the conversation centered on how I learned of my impending kidney failure and  the timeline of the failure. We then shifted to a picture of what they currently envision as their delivery system. It was at this point that I hit a snag. Unlike Abbott’s Libre 3 system for glucose readings which is a “one and done” every two weeks, Metyos’ system lasts eight days, and at that time the user must use a tool to replace a sensor in a receiver which remains attached to the user. In addition, at some interval not discussed, the user must wear a cuff-like device to charge the sensor’s battery. Ok so far?

Here’s the deal. The average age of those experiencing CKF tends to be upwards. Kidney disease can develop at any time, but those over the age of 60 are more likely than not to develop kidney disease. As people age, so do their kidneys. According to recent estimates from researchers at Johns Hopkins University, more than 50 percent of seniors over the age of 75 are believed to have kidney disease.

An herein lies the problem. Without insulting anyone, seniors in general are less apt to be comfortable with technology-based solutions. They tend to lose dexterity and just might find it difficult to manipulate the delicate touch required to change sensors. Not stated before, but like the Libre 3 system, the Metyos system uses a smartphone for analysis and display. Seniors in general shy away from smartphones and even if they have them, do not use the vast majority of their bells and whistles. For instance, my wife has three sisters all over 75 who don’t use the text function of their phones but you better believe they take pictures of grands and great-grands.

Lastly, I know for 100% certainty that FDA approval of the Abbott Libre 3 system to be covered by Medicare was held up until such time as Abbott developed a stand-alone reader for the Libre 3. When my first shipment of Libre 3 sensors was delivered from a third-party vendor, I received a reader with the shipment.

The Metyos system is set up to measure potassium (K) as a predictor of CKF. I was not familiar with this and quizzed Perplexity with the following results:

Potassium (K+) levels are an important predictor of adverse clinical outcomes in patients with chronic kidney disease (CKD). Several studies have demonstrated the following key points:

• There is a U-shaped association between serum potassium levels and the risks of mortality and major adverse cardiac events (MACE) in CKD patients

. Both low (<4.0 mmol/L) and high (>5.0-5.5 mmol/L) potassium levels are associated with increased mortality and MACE risk compared to normal potassium levels (4.0-5.0 mmol/L). Hyperkalaemia (serum K+ >5.0-5.5 mmol/L) is associated with an increased risk of renin-angiotensin-aldosterone system inhibitor (RAASi) discontinuation in CKD patients, exhibiting a J-shaped relationship. RAASi medications are important for slowing CKD progression. Spending more time in a hyperkalaemic state (higher percentage of follow-up time with K+ ≥5.0, 5.5 or 6.0 mmol/L) is associated with increased risks of mortality and MACE across various cardiorenal disease populations, including CKD. High variability in serum potassium levels over time is also an independent predictor of increased MACE risk in CKD and other cardiorenal diseases, though not consistently associated with mortality risk. Other important predictors of adverse outcomes in CKD include older age, male sex, lower estimated glomerular filtration rate (eGFR), history of MACE, and RAASi usage

• .

In summary, both high and low serum potassium levels, increased time spent in hyperkalemia, and high potassium variability are significant predictors of mortality, cardiovascular events, and RAASi discontinuation risk in CKD patients. Maintaining normokalemia is crucial for improving outcomes in this population.

I recently ran across an article on the Fresenius-sponsored app, Patient Hub. In the blurb, CKD and dry skin aka Pruritus were discussed. Further research indicates that as many as half of dialysis patients are blessed with aP. As such, it behooves those of us on PD to know more about this situation.

What is pruritus?

The general term pruritus means very itchy skin caused by a long-term disease, such as chronic kidney disease (CKD).

What is chronic kidney disease-associated pruritus (CKD-aP)?

CKD-aP is very itchy skin that is most common in patients with advanced CKD and end-stage kidney disease (ESKD), but it can also happen in the early stages of CKD. CKD-aP is also known as uremic pruritus because the build-up of toxins and wastes in damaged kidneys, known as uremia, has been associated with itching.  Recent scientific evidence suggests uremia is not the exclusive cause of itching in CKD.  As a result, the more appropriate name for this condition is CKD-aP.

CKD-aP can bother patients a lot and get in the way of daily life.  Scratching to stop the itch can harm the skin, so finding the right treatments is very important.  CKD-aP affects each person differently, so you need to work with your doctor and healthcare team to find what works best for you. Because CKD-aP is often ignored by both patients and their healthcare team, patients may not get the relief they need.  This can lead to loss of sleep, shorter or missed dialysis sessions, fatigue, depression, and infections, among other problems. 

On a personal level, I have experienced scaly or rough patches on my skin often on my head and legs. Since I am also a diabetic, this also factors in. Several years ago my dermatologist suggested I use a prescription ointment named Triamcinolone Acetonide (lead picture.) It has worked wonders for me dispatching sore spots and itching in short order.

As mentioned in yesterday’s blog, I did contact my dialysis team nurse, requested several boxes of 2.5% 2-liter static dialysis fluid, and picked up four boxes this morning. So now time will tell if I can control my weight using only the 2.5% static bags. Having said that, I would like to inform readers that for an 85-year-old 100% disabled Navy Vet, I am feeling exceptionally well at this point, working hard in the yard, and looking forward to living. Yes I have to pace myself, and yes I have to rest regularly, but things are getting done. I even laugh and smile occasionally. Life is good.

Yesterday exactly on time as advertised, our roofer and the USAA Insurance estimator showed up and investigated hail damage on on roof from the May 9 hail storm previously reported. The estimator found that our roof had sufficient damage from the storm to necessitate replacement, along with several of the gutter guards, and the door to our single garage also has dents in it. All of this info was sent back to USAA and I have been informed (via phoncon 5/14/2024) that our claim is in the mill and should be completed within a matter of day.

Lastly for today’s blog, after years and years of a certain cereal for breakfast, in response to constant nagging as a result of my labs reporting I need more protein, with the help of my wife, I’ve worked eggs and sausage into my breakfast routine. I’ve also included “smear case” for supper on occasion.

Just about everything in Texas is bigger, even HAIL. This past Friday around 1635 the skies opened up and here in Pecan Plantation, depending on where you live (we are about 4400 acres), a golf-ball to softball-sized hail storm passed through, lasting about 10 minutes. Boy did it rip things up. No sooner than the last hail had bounced off roofs, the roofers were coming out of the woodwork, harking their particular company for roof replacement work. We got ahead of the curve, notified our home insurance agent at USAA, have an adjuster scheduled for 10-11 AM today, and a reputable local roofing company on call to also work with the adjuster. The roofing company’s rep came out Saturday and inspected our roof and said it needed replacement. We have three skylights, and the storm took out all three. What you don’t know is that the roof is only three years old having been replaced previously due to hail damage. So here we go again.

Here is a link to a DFW article about the damage in Pecan Plantation. Below is a short video I shot during the hail storm. It is shot from our front porch.

As scheduled, we received our monthly supply delivery from Fresenius. Our storage space is filled to the brim. The first photo below shows the “Ready Service Locker ” adjacent to the Liberty Cycler in our Master Bedroom. I currently use two bags of 6-liter fluid every night, so our locker holds ten nights’ worth of fluid.

The photo below is of a closet in a bedroom adjacent to the Master. In it, we store all of the bulk of fluids. To the right in the picture is our supply of 1.5% 6-liter bags; on the floor under the center shelving are the eight 2.5% 6-liter supplies I will be working in to help alleviate my weight gain; to the left are the 2-liter static bags I use in the early evening. As you can see, it makes up quite a bit but keep in mind I’m using one box of 6-liter every night so it goes down rather quickly.

Yesterday I alluded to mashing up a quick video of some of the yard work that my wife and I are engaged in. At this time of year in North Texas, we have to get out early or late to escape the heat. At 1:30 PM it is currently 86F with high humidity; tomorrow the high is predicted to be 92F so you get the idea. Our property is 0.5211 acres, more or less, with 15 or more flower beds. It is a handful to attempt to keep up with but we are doing just that. We have professional mowers on call, and a hit-and-miss high school lad helping us. It is still rather daunting but isn’t life itself? Keep-up is not in the cards nor is staying even but that’s what challenges are all about, right? Above all else, it makes for a very good counterbalance to the requirements of peritoneal dialysis. Here’s the short of what we have been working on:

I am scheduled for a Monthly Dialysis Team Meeting this Thursday at 0845. I don’t expect any surprises as we have been in the groove, so to speak, except for my concern about weight which appears we are approaching a solution. After using 2.5% 2000 mL for my static Sunday night my weight dropped from 148.4 to 148.0 and ultrafiltration was over 1000. We’re headed incrementally in the right direction.

Regarding my labs: My Albumin dropped to 3.4 from 4 so is below desired. My Calcium dropped to 8.2 from 8.7 and is below desired. My Glucose was 84 down from 149; I didn’t eat any breakfast before labs this time which explains this reading. Interestingly, my Creatinine was 8.76, down from 9.22 and “going in the right direction.” This maps to an eGFR of 5 putting me still in the toilet.

We’ve been steadily working in the yard. This AM my wife and I planted eight Lantana and used a pick to remove some rusted steel bed edging. Our twelve Roma tomato plants all have blossoms and are looking very healthy. A short video clip will be provided in a couple of days. I still get winded easily and have to rest frequently but we’re “gettin’ ‘er done!”

As previously reported herein, since I have been using only 1.5% fluid for my peritoneal dialysis, my weight has crept up from a target dry weight of 143 pounds to 149. Last week, I called Fresenius Supply and am to receive, in addition to my regular supply order, an additional 8 boxes of 6 liters of 2.5% solution.

Before this gets too confusing, let’s review: My current prescription for PD using the Liberty Cycler is a single manual fill of 2 Liters at approximately 6 PM followed by hooking up to the Cycler at about 9:30 PM where there is a drain, followed by four fill/drain cycles of 2700 mLiters each, or a total of 10,800 mLiters. Following this routine/prescription, my last adequacy test of Kt/V of 1.98 is acceptable. My dialysis is working and the Kt/V suggests is adequate.

To preclude leg cramps, I tend toward using a 1.5% solution for all of my PD. My weight gain suggests this does not result in pulling enough fluid. Previously when I was mixing 1.5 and 2.5% solutions, my ultrafiltration, a measure of how much fluid is being removed, was consistently over 1000; now, with 1.5%, it is as low as 378 but mostly in the 6-800 range. The obvious solution is to work in more 2.5% solution but how much is the question?

When the 2.5% 6 liter arrives, I intend to work in a 6 Liter bag of 2.5% every other night as a starting point. I use two 6-liter bags per night, so this will be providing roughly half of the required fluid. Meanwhile, while straightening out our supply closet, I found five 2 Liter static bags and used one of them Saturday evening for my static fill. Sunday morning my weight, which for the last three mornings was 149.0, dropped to 148.4, and my ultrafiltration jumped up to 1109 from 654. This suggests to me that perhaps I can alleviate my weight gain by just using the 2-liter static fill at 2.5%. I did have a slight leg cramp but not of the severity that I had to get up out of bed and walk around. I will be using the 2 liter 2.5% bags for my static fill until Wednesday. I’ll let you know how it goes. There is no formula for this stuff, just cut and try as it were.