Tuesday morning my weight ballooned to 158.0 pounds and I felt worse since going on PD. I had asked my dialysis nurse to read Tuesday’s blog about my weight going up (drastically) since going on the latest prescription which she did and talked to my nephrologist. As a result, I have a new dialysis prescription to try out. This one involves manually loading 2L of 2.5 around 6 PM. This load will be drained off by the initial drain cycle of the evening and be followed by four cycles of 2.7L each but no additional fill at the end.
Remember that every time my prescription changes, the requirements for what fluids in what amounts per bag change also. So now I need enough 2L manual bags for one per day and enough other inventory to cover four fills of 2.7L each. Since I normally only inventory manual 2l bags to conduct adequacy tests, I only have 3 boxes or 15 bags on hand. While I was in the clinic having my thumb drive reprogrammed for the new prescription, I called Fresenius Logistics and have an additional five boxes of the manual bags scheduled for delivery next Tuesday. I have found Fresenius very easy to work with in this regard.
Now I’m trying to decide if I need to do a manual drain to get rid of this excess fluid loading me down?
This past Friday I had an appointment at the Fort Worth VA Clinic for new glasses. Let me diverge for a minute with some background. This past January I contacted the VA for an appointment to be fitted with new glasses. My current VA-provided glasses are approaching five years old and my prescription has changed; I need new glasses. At my initial contact with the VA, I was informed that the earliest appointment I could make was April 8, more than three months in the future. OK, I went with that, only to receive a call earlier last week that the doctor I had an appointment with had been called up to active duty, and now, the earliest appointment was in August.
This is obviously outlandish so I objected – politely, and was told there was an appointment available at 1020 on Friday which I took. I was informed, however, that my appointment was with an Ophthalmologist versus the optician who was called up. I was told no problem, he would take care of my glasses. OK so far.
Upon arrival at the clinic, some 33 miles and an hour’s drive from our digs, I was rapidly checked in and during my initial phase had dilation drops placed in my eyes. This was my first sign that yet another FUBAR was taking place. I have never in my 85 years had my eyes dilated for glasses fitting. When I was called in to so the doctor, I immediately questioned what was going on and it was I thought, FUBAR was at work. No one had informed him that I was in for only glasses and he proceeded to check me for cataracts and diabetic retinopathy as well as vision. He provided a script for glasses, I went down the hallway to the optical shop, and in less than 10 minutes had picked out new frames and completed all the paperwork required. I should receive new glasses in the mail in my lifetime, hopefully.
Recall that this past Thursday I met with my Dialysis Team. As a result of my latest PET indicating that my Transport flipped from High to Low, my prescription was altered. Part of this change was to leave one liter of fluid in my stomach after my daily treatment where it would be removed first upon hooking up for treatment in the evening.
After unhooking every morning, I now have three data points on my weight. My weight had run consistently at 146.8 or 147.8 for weeks and months. The last three readings are 150.0, 152.2, and 155.8. According to a Perplexity search, PD fluid typically weighs about 1 Kilogram per liter depending on the solution. So retaining a liter of fluid should raise my weight by about 2.2 pounds (one kilo). This would make my current weight to be about 150 lbs max (147.8 + 2.2 = 150). This would infer that my first weight is “in there” while the 152.2 and certainly the 155.8 are out in left field.
BTW, my closing screen on the Liberty Cycler, the machine that conducts the PD treatment, indicates clearly that 1007 mL of fluid constituted the last fill. Associated with the 155.8 weight was a negative microfiltration of 494 indicating that some fluid over the 1007 was left in after treatment but this would not explain the 155.8. Bottom line, I don’t have a clue what is going on. Standby! And I don’t see how I can do a StatDrain either. This morning my wt was 155.2 with positive microfiltration of over 800.
I met with my dialysis team yesterday as planned to go over my early March labs. As anticipated, a central point of discussion was what to do in response to the change in my transport function. The following was decided: Reduce the number of dwells to 4 from 5, increase dwell time to 2 hours from 1.5 hours, and add a one-liter dwell during the day. The daytime one liter will be accomplished by loading a liter into my stomach in the morning, where it will remain all day until I hook back up to the cycler at night where it will be first removed before any normal fill and dwells occur.
A downside to having a liter of dialysis fluid in your gut during the day is the possibility of some of it being reabsorbed back into the body. Since the fluid also contains a fair amount of sugar, I was told it MAY impact glucose control.
I was politely chided by my dietitian Rachel to up my protein intake which I will accomplish by attempting to consume more red meat and more protein bars.
First of April, we will run yet another adequacy test the output which will be an updated Kt/V which hopefully will move upward from the current 1.8 more towards 2.0, the ultimate minimum goal.
The lead picture is from Poe in response to the Prompt: “picture of Popeye pondering his new dialysis prescriptions’
As advertised, yesterday at 1000, I visited my GP for my annual physical. There is nothing untoward to report. First of all, the check-in nurse couldn’t believe I was 85 because I was walking unassisted, getting up on the examination table unassisted, and responding quickly and accurately to all of her many questions. My EKG was strong and normal; every other parameter checked was great. My blood pressure was 110 over 69; it is obvious I have no white coat syndrome. We got all the prescriptions I needed in order, and now everything is good. I received notification from ExpressScripts that they also received the order, which is always good.
So, from my GP, “See you in three months!” (Picture is from Poe in response to Prompt “picture of Popeye happy over annual physical with GP”
Recently, AI has been at the forefront of many heated discussions in the press. I have embraced it with the understanding that, like humans, it is not perfect but, in most cases, better than existing research tools. I recently quizzed Perplexity about the field of research into new and diverse methodologies to treat CKF with the following interesting results:
Recent discoveries in the field of nephrology have been made with the help of artificial intelligence (AI), which is increasingly being used to improve various aspects of kidney transplantation and treatment. A study from the University of Texas at Dallas, reported on July 14, 2023, revealed a new mechanism for kidney cell renewal. This discovery pertains to a “housekeeping” process within kidney cells that ejects unwanted components, which could have significant implications for understanding kidney function and diseases2.AI is also being utilized to transform organ transplantation. For instance, Mayo Clinic transplant specialists are confident that AI will be a valuable tool to improve the complex organ donor and recipient matching process. AI’s ability to analyze large datasets is expected to uncover important trends and patterns that can aid in early detection of organ failure, improve matching processes, and potentially increase the number of organs usable for transplant3. Moreover, The Kidney Project has made strides in developing a prototype bioartificial kidney, which aims to free patients from dialysis machines and transplant waiting lists. This project has successfully tested a functional prototype, which combines a hemofilter and a bioreactor, and is powered by blood pressure alone without the need for blood thinning or immunosuppressant drugs4.In addition to these practical applications, AI is also being recognized as a new field of knowledge for nephrologists. It offers the potential to improve diagnostic accuracy, treatment, and prediction of kidney diseases. Machine learning algorithms, a subset of AI, can be trained to recognize patterns in patient data to identify early signs of kidney disease, which could lead to timely diagnoses and treatments5.These advancements in AI and its applications in nephrology are paving the way for increased automation, standardization, and speed in medical evaluations, which will ultimately enhance precision medicine and improve patient care135.
It. should be very apparent that researchers are indeed employing AI in their efforts to improve life for those experiencing or on the path to experience CKF. The lead picture was generated by my AI assistant Poe in response to the Prompt “Picture of Popeye pondering the concept of artificial intelligence.”
My wife and I just had a whirlwind weekend. Our grandson, wife, and seven-month-old great-granddaughter flew in from Seattle for a short visit. We drove about 70 miles to Dallas Love Field to pick them up. It wasn’t too bad traffic-wise Saturday or going back up Monday, but coming back we got in lots of slow and start-stop traffic on the 820. It was very nice seeing them and getting acquainted with the new GGD. Our golden retriever behaved himself extremely well.
Have several activities coming up this week. On Wednesday I have a Fresenius supply delivery and an annual physical. Thursday I have a dialysis team meeting, and Friday I’m scheduled to turn in our tax records to our CPA so she can do our 2023 Federal taxes. I also uncovered a new topic that should prove to be of interest to readers of this blog that I intend to develop tomorrow. Stay tuned.
Last week, the FDA cleared the use of a new-to-market Continuous Glucose Management device named “Stelo” by Dexcon. It is reportedly a dumbed-down version of their G7 device competing with the Libre 3 from Abbott that I currently use. It is to be sold OTC without requiring a prescription and lacks some of the bells and whistles of the G7 such as high and low alarms etc. I would guess that it will be priced at a lower point than their current device and diabetics, as well as the broader target market, will also tend to use it. We’ll see. Read about it at this link. Dexcon’s stock has gone up by 10% since the announcement.
BTW, “Stelo” doesn’t seem to translate to anything, but “Steelo” means “style” in Spanish.
Recently (Link) it was reported that nano and microplastics are increasingly becoming a real threat to our health and wellbeing. While the research cited in general has to do with these plastics in the bloodstream, it is conjectured that they exhibit a deleterious effect on the kidneys also and thus are of interest to those of us on dialysis and sensitive to causes of CKF.
In this blog, I intend to first provide current definitions of and causes of the phenomena of microplastics followed by a survey of current research into the impact of the same on kidneys. Perplexity was used throughout.
What are microplastics and how are they produced?
Microplastics are tiny plastic particles, typically less than 5mm in diameter, that are a significant concern due to their harmful effects on humans, wildlife, and ecosystems. These particles originate from various sources, including the breakdown of larger plastic items and the intentional design of small plastic particles for specific functions like microbeads in beauty products12. Primary microplastics are intentionally produced small plastic particles, while secondary microplastics result from the degradation of larger plastic items due to environmental factors like UV radiation and exposure to sea waves12. Microplastics are found in oceans, lakes, waterways, soil, air, and even in food products like seafood and table salt2. They pose environmental risks by being ingested by marine life and accumulating toxic chemicals that can harm ecosystems2. In terms of human health impacts, research suggests that humans ingest microplastics through food and water, with potential risks including inflammatory responses, cancer, infertility, and other health issues depending on factors like size, shape, polymer type, and exposure levels3. Efforts are needed to better understand and mitigate the risks associated with microplastics to protect both human health and the environment3.
What has research found concerning microplastics and their impact on kidneys?
Research has found concerning evidence regarding the impact of microplastics on kidneys. Studies have shown that microplastics, particularly polystyrene microplastics, can lead to histological and functional alterations in kidney cells, including autophagy, oxidative stress, and inflammation
34. These effects are mediated by processes like inflammation, oxidative stress, and lipid disturbance, which can result in decreased kidney function and structural damage in kidney tissues35. Additionally, research indicates that microplastics can induce nephrotoxicity associated with oxidative stress, inflammation, and endoplasmic reticulum stress in juvenile rats, leading to decreased growth rates and organ index changes5. While further studies are needed to fully understand the extent of microplastics’ impact on kidneys, the existing evidence highlights the potential risks posed by these tiny plastic particles to renal health.
I had a lab with my dialysis nurse on Monday and a visit to my Podiatrist on Tuesday. First to my labs.
I am thrilled with the way Fresenius does labs. I go into their local hub one day, and the following day, often first thing in the morning, summary results are available via their PatientHub. It works slick if you are up on their phone app. My Potassium, Calcium, and Phosphorus were all within limits which I’ll take to the bank. My glucose was high but I had breakfast before going to the lab so I was not fasting.
My dialysis nurse and I discussed what my kidney doctor might prescribe in response to my Transport flipping from high to low. While we can’t second guess her, it was speculated that she might keep my fluids the same, 13,500 mL total, reduce dwells from 5 to 4, and increase dwell time from one hour 30 minutes to two hours. We have a team meeting scheduled for next week so I’ll find out soon her new prescription.
Regarding the Podiatrist visit: I see my podiatrist once every three months where he trims my toenails, inspects my feet and ankles, and an assistant polishes my nails with a grinder. This is all covered by Medicare and is part of taking care of my feet due to diabetes. My dialysis nurse also checks my feet monthly including between my toes etc. so I’m taken well care of in this area.
Yesterday was my Brother-In-Law Jerry’s 84 birthday. They hosted a pizza party for him in Mulberry, Indiana. Keep in mind Jerry, that no matter how old you become, I’ll always be your elder! The lead gra[phic is the closest I could come for a custom congrats to you via Ai.
