Tag: setup (Page 11 of 43)

I was fortunate enough to have several Indian students in my classes when I taught at Purdue University. I consistently found them to be more than a cut above competing students from both other countries and certainly the USA. I ran across an article recently in the WSJ about the Indian population. The thrust of the article was that they don’t complain, don’t seek quota advantages, they just go about excelling. I used Poe to extract in bullet point format the highlights of the Indian population in the USA which is provided below. They ARE gaining on the US population in just about any important category you can imagine. Following from this link.

• Indians constitute just under 1.5% of the country’s population.
• Two Indian-Americans (Nikki Haley and Vivek Ramaswamy) competed for the Republican presidential nomination in 2023.
• Vice President Kamala Harris was born to an Indian mother.
• Indian-American CEOs run major companies like Google, Microsoft, Novartis, Starbucks, FedEx, Adobe, and IBM.
• Indian-Americans have the highest median household income in the U.S. by ethnic group, almost twice that of white households and three times that of black households.
• Two-thirds of Indian-Americans have college degrees, and 40% have postgraduate degrees.
• Indian Americans have the lowest divorce rates of any ethnic group in the country.
• Indian Americans own 60% of all hotels in the U.S.
• One in every 20 doctors in the U.S. is Indian, and 1 in every 10 students entering medical school is Indian.
• Indian deans are common at top U.S. business schools, including Chicago, Georgetown, Harvard, Northwestern, and New York University.
• Indian Americans are not known for grievances or pushing for increased “representation” or special accommodations.
• Indian-Americans are unapologetic about their drive to thrive and believe in the American Dream.

I have recently related my weight gain and my action to do something about it. In review, In a matter of days, my weight increased from 139.6 to 144.2 with no changes in ANYTHING – same diet, same exercise, same dialysis. I informed readers that I was going to start using 2.5% bags for my static afternoon fill which I did to no avail. My weight instead went up to 144.6. So, again as I previously suggested, I switched to a 2.5% static bag AND a 2.%5 6 L bag for my evening on the Liberty Cycler, along with an additional 1.5% 6 L bag. My weight with this in one evening dropped to 144.2 and the morning microfiltration was 907, up from the 28, 0, 73, and 71 on previous mornings.

I intend on continuing with the 1/5 and 2.5 % 6 L bags until my weight gets back down in the 140 +/- range, and then switch back to all 1.5% bags. I have zero confidence at this point that I won’t have to repeat the above sequence. History does have a way of repeating itself – reminds me of Churchill:

Winston Churchill famously emphasized the importance of learning from history to avoid repeating past mistakes. His well-known quote on this topic is:

“Those that fail to learn from history are doomed to repeat it.”[1][4]

Churchill delivered this line in a 1948 speech to the British House of Commons, paraphrasing an earlier sentiment expressed by philosopher George Santayana[3][4]. The full context of Churchill’s statement emphasized the need to study and understand historical events to make better decisions in the present and future.

This perspective aligned with Churchill’s deep interest in history. He was known to be an avid reader of historical works, particularly Shakespeare, Gibbon, and Macaulay[4]. Churchill believed that studying history provided valuable lessons and insights that could be applied to contemporary challenges.

Churchill put this philosophy into practice during his leadership in World War II. He drew upon his knowledge of history, including Shakespeare’s works, to inspire and guide his actions during critical moments[4]. For example, he invoked Henry V’s speech before the Battle of Agincourt to rally British resolve during the London Blitz.

The enduring popularity of Churchill’s quote reflects a widespread belief in the value of historical knowledge for informed decision-making and avoiding past errors. It serves as a reminder of the importance of learning from previous experiences, both successes and failures, to shape a better future[1][5].

Citations:
[1] https://liberalarts.vt.edu/magazine/2017/history-repeating.html
[2] https://www.medicalconfidence.com/blog/those-that-fail-to-learn-from-history-are-doomed-to-repeat-it-winston-churchill/
[3] https://www.invasiveplantswesternusa.org/history-are-we-doomed-to-repeat-it.html
[4] https://winstonchurchill.org/resources/in-the-media/churchill-in-the-news/folger-library-churchills-shakespeare/
[5] https://www.nwfdailynews.com/story/opinion/2020/06/11/letter-dont-make-me-repeat-myself-history/41983691/

For weeks my weight has been in the 139.6 – 142.2 range with UltraFiltration ranging from 493 to 2072, all this while on 1.5% solution. The last couple of days things have drastically changed. In the last three days, my weight has been 142.0, 143.0, and 144.2. Correspondingly, my UF has been 28, 0, and 73. I am retaining fluid. But this begs the question why all of a sudden? Nothing has changed with my routine, exercise, diet, dialysis, etc.

To counteract this tendency, starting tonight I’m using a 2 L bag of 2.5% for my static fill. I’ll try this, and if this doesn’t bring my readings around I’ll start mixing in 2.5% 6 L bags as needed. Recall my reluctance to use higher solutions than needed is based on my dialysis nurse informing me that higher percent solutions are harder on your stomach lining and over time can cause the efficacy of the PD process to degrade – not a good thing. So it is my overreaching goal to stay as close to 1.5% as possible.

The whole point of this blog is not the nitty gritty of my dialysis prescription, but that while the steady state is a goal, it’s not easily achieved. Things change all the time in the Peritoneal Dialysis world. We have to adapt.

Last week I blogged that I was being put on Renaplex D and I included all the good things that are associated with its intake from Perplexity. What was not included was just what Renaplex D consists of from a component viewpoint. This blog adds that information plus the results of my B12 lab are in. I have included the lab in the header. As you can see, my B12 level is smack in the middle of the lab-provided range but where we go from here I won’t know until my next team meeting in a couple of weeks. See below for what Perplexity indicates constitutes Renaplex D:

Based on the search results, Renaplex-D is a multivitamin and mineral supplement that contains the following components:

1. Vitamin D3 (2000 IU)
2. Vitamin E (35 IU)
3. Vitamin C (60 mg)
4. Thiamine (1.5 mg)
5. Riboflavin (1.7 mg)
6. Pyridoxine (10 mg)
7. Cyanocobalamin (6 mcg)
8. Pantothenic Acid (10 mg)
9. Biotin (300 mcg)
10. Niacinamide (20 mg)
11. Zinc (12.5 mg)
12. Selenium (70 mcg)
13. Folic Acid (800 mcg)[9]

The supplement also contains other ingredients such as microcrystalline cellulose, stearic acid, croscarmellose sodium, FD&C Yellow #6, magnesium stearate, and silicon dioxide NF[9].

It’s worth noting that Renaplex-D is a prescription medication used to treat or prevent vitamin deficiency due to poor diet, certain illnesses, or during pregnancy[11]. The supplement is designed to provide essential vitamins and minerals to help maintain good health and address specific nutritional needs[11][12].

Citations:
[1] https://www.pureformulas.com/product/vitamin-d3-1000-iu-by-pure-encapsulations/1000002501?skuId=PE1634
[2] https://irwinnaturals.com/products/high-potency-d3-k2-complex?currency=USD&variant=32209598775414
[3] https://www.amazon.com/Nature-Made-Vitamin-Selenium-Supplements/dp/B0B8Q83NV6?psc=1&smid=ATVPDKIKX0DER
[4] https://www.algaecal.com/products/vitamin-d3-complete/?item=DC1-V
[5] https://blueskyvitamin.com/products/vitamin-d3-5000-iu-pure-encapsulations?currency=USD&variant=41782975365304
[6] https://www.herbkart.com/vitamin-d3-cholecalciferol-supplement-5000-iu-60-liquid-filled-capsules/
[7] https://www.naturemade.com/products/vitamin-d3-maximum-strength-10000-iu
[8] https://www.ebay.com/itm/156087297795?chn=ps&mkcid=28&mkevt=1&var=456811908892
[9] https://nephrotech.com/product/renaplex-d/
[10] https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=9ac36ba6-c47e-4429-902a-3be9ef6e9d48&type=display
[11] https://www.webmd.com/drugs/2/drug-174969/renaplex-d-oral/details
[12] https://qwarkhealth.com/drugs/renaplex-d/
[13] https://www.drugs.com/sfx/renaplex-d-side-effects.html

During my lab visit yesterday, I was asked if I was taking Renaplex D to which I replied no. Later on, I received an email from my dietician stating that a script had been sent to Fresenius for this RX. Since I have never taken or heard of Renaplex D, I turned to Perplexity to find out more about it. Read on:

Renaplex-D is a multivitamin supplement specifically formulated for patients with kidney disease, including those on peritoneal dialysis. Here’s an explanation of its use for patients on peritoneal dialysis:

1. Addressing vitamin deficiencies: Patients on peritoneal dialysis often experience vitamin deficiencies due to dietary restrictions, poor appetite, and loss of vitamins during dialysis treatments. Renaplex-D is designed to supplement essential vitamins that these patients may be lacking[1][3].
2. Customized formulation: Renaplex-D contains a specific blend of vitamins tailored to the needs of dialysis patients. It typically includes higher amounts of water-soluble vitamins (such as vitamin C, B-complex vitamins, and folic acid) that are lost during dialysis and need daily replacement[3].
3. Avoiding harmful ingredients: Unlike over-the-counter multivitamins, Renaplex-D does not contain high levels of vitamins A, E, and K, which can build up to harmful levels in patients with impaired kidney function[3].
4. Supporting overall health: Regular use of Renaplex-D can help maintain proper vitamin levels, potentially improving overall health and quality of life for peritoneal dialysis patients[3].
5. Preventing complications: Adequate vitamin D supplementation, which is often included in renal vitamins like Renaplex-D, may help prevent complications associated with peritoneal dialysis, such as peritonitis[4].

It’s important to note that patients should always consult with their healthcare provider before starting any new supplement, including Renaplex-D. The dosage and specific formulation may need to be adjusted based on individual patient needs and lab results. Additionally, patients should be aware that some brands of renal vitamins may not be suitable for those with severe kidney disease or on dialysis, so it’s crucial to use only the formulation prescribed by a healthcare professional[5].

Citations:
[1] https://www.webmd.com/drugs/2/drug-174969/renaplex-d-oral/details
[2] https://www.jrnjournal.org/article/S1051-2276%2805%2900186-X/pdf
[3] https://www.davita.com/diet-nutrition/articles/basics/renal-vitamins-for-people-on-dialysis
[4] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6883549/
[5] https://www.singlecare.com/prescription/renaplex-d/what-is

I’d like my viewers to know that my peritoneal dialysis, with all its ups and downs, is in general going well. Yes, at times I get tired, especially after working out in the North Texas heat for several hours, but hey, I am on dialysis and 85 years old so what’s to expect? Tomorrow morning I have a lab appointment to check my B12. Not certain what that’s all about but my kidney doctor wants it checked. Other than that, my weight is staying in the low 140s, glucose is good, etc., what’s not to like?

Traveled to see my Audiologist yesterday. Turns out my Starkey 24 state-of-the-art hearing aids have a few glitches. For one, they don’t always stay hooked up to my phone via Bluetooth so my phone has to be rebooted. Sometimes the earpiece itself must be turned on and off to reestablish connection with the phone and so on. Recall that Starkey 24 is pushing technology to some extent using AI to fine-tune them to the environment you’re in so I guess some glitches are to be expected. Regardless, I like the Starkeys and will continue to use them.

r

Yesterday I received a call from my dialysis nurse. She informed me that my nephrologist had reviewed my most recent lab report and wanted to make some changes. She is concerned about my Hemoglobin being so high (14.5) which has a lab range of 14-18. Mine is too high for someone on PD. Secondly, my iron is in the over 800 range and the lab range is 22-322. I have been taking OTC iron supplements which I was instructed to stop. Additionally, she wants labs on my B12 for which I have been taking an injection every two weeks. On top of that, in question is if I should continue testosterone injections which I currently take every two weeks.

As you can ascertain from the above, there are lots of moving parts. See graph below:

The results from my Adequacy Test (more on this nomenclature later on) and my labs in general are in. As you can view in the lead graphic, my Kt/V, captured by the Urea Index, has significantly increased to 2.29, or as my local Fresenius clinic would report, 2.3 rounding the number to one decimal place. While on the surface this would appear to be “good,” to me it raises the question “How much Kt/V is “enough?” or “What value is medically indicated?”

This is where “medicine” is all over the place. Let me explain. The Nurse practitioner who recently visited with me last week stated the “government’s” criteria is 1.4 or better. My local Fresenius clinic sets a minimum of 1.7 as do several other entities. From the graph above, you can see the lab sets a minimum of 2.0 with no upper bound as do several other entities. I have to live with the environment where I am so as long as I am above 1.7 I may have discussions with my team, and if I’m above 2.0 get atta boys. But this still begs the issue of how much is enough.

My copious research turned up this statement: “The updated January 2020 ISPD guidelines reflect the changes mentioned above including a shift in terminology used to describe the proper amount of dialysis attained from “adequate” to “goal directed,” including multiple aspects to meet optimal “goal directed” care, including residual kidney function, nutritional status, and patients’ sense of well-being and satisfaction with their treatment. The effect of the burden of time spent fulfilling their dialysis prescription on their ability to carry out normal day-to-day tasks and their psychosocial status are now included as important factors in assessing if dialysis prescriptions are adequate. Finally, it is now mentioned that there is no specific target for clearance to meet to ensure PD prescriptions are satisfactory (15). … Finally, we have seen a growth in the field of nephrology in which the term “adequacy” has developed from a synonym for clearance of a single small solute to a term for a holistic assessment of the patient. We have learned that in PD, there is such a thing as too much of a good thing. Link to source for quotes above.

OK, so instead of “Adequacy Tests” we should be goal-directed based on patients’ input. It still begs a response to the question “How much Kt/V is enough? which we may attack through the question “What harm, if any, results from higher Kt/V?” I turned to Perplexity with this question with the following results:

For peritoneal dialysis patients, what is really good kt/v

Answer

For peritoneal dialysis patients, a Kt/V of 1.7 or higher per week is generally considered good. This target value has been recommended by guidelines from organizations like the International Society for Peritoneal Dialysis (ISPD) and the Kidney Disease Outcome Quality Initiative (K/DOQI). However, it’s important to note that the relationship between Kt/V and clinical outcomes is not straightforward. Some studies have shown that achieving higher Kt/V values may not necessarily lead to better survival rates. The ISPD in 2020 stated that there was a lack of high-quality evidence to prove the impact of Kt/V on survival and mortality, and reaching Kt/V > 1.70 may not bring additional survival advantages. Recent research suggests that the Kt/V reach rate – the percentage of Kt/V measurements that reach the target threshold – may be a more representative index to assess clinical status. Patients who consistently achieve the target Kt/V (3/3 times) or intermittently achieve it (1/3 or 2/3 times) have been shown to have better clinical outcomes than those who never reach the target. Ultimately, while a Kt/V of 1.7 or higher is considered good, it’s essential to consider other factors such as how the patient feels, their overall health status, and their residual kidney function when assessing dialysis adequacy.

SourcesKt/V reach rate is associated with clinical outcome in incident …tandfonline·1Kt/V reach rate is associated with clinical outcome in incident … – NCBIncbi.nlm·2Peritoneal dialysis adequacy: a paradigm shiftkrcp-ksn·3

Rather than ask “How high should Kt/V be,” perhaps we should ask Perplexity another question “What are the risks associated with higher Kt/V targets in PD patients?”

Answer

While higher Kt/V targets are often considered beneficial for peritoneal dialysis (PD) patients, there are some potential risks and considerations associated with pursuing higher Kt/V values:

1. Increased peritoneal exposure: Achieving higher Kt/V may require more frequent exchanges or larger volumes of dialysate, which can lead to increased exposure of the peritoneal membrane to glucose and other potentially harmful substances.
2. Peritoneal membrane damage: Over time, excessive exposure to dialysis solutions can cause structural and functional changes in the peritoneal membrane, potentially leading to ultrafiltration failure.
3. Loss of residual renal function: Aggressive pursuit of higher Kt/V targets might inadvertently accelerate the decline of residual kidney function, which is crucial for PD patients’ overall health and survival.
4. Diminishing returns: Studies have shown that achieving Kt/V values above 1.7 may not provide additional survival benefits. This suggests that there might be a point of diminishing returns where the risks outweigh the potential benefits.
5. Quality of life impact: More frequent or longer dialysis sessions to achieve higher Kt/V targets can negatively affect a patient’s quality of life and daily activities.
6. Increased risk of complications: More intensive dialysis regimens may increase the risk of peritonitis, exit-site infections, or mechanical complications related to the PD catheter.
7. Nutritional issues: Overzealous removal of uremic toxins might lead to the loss of essential nutrients, potentially affecting the patient’s nutritional status.

It’s important to note that the relationship between Kt/V and clinical outcomes is complex, and individual patient factors should be considered when determining optimal dialysis prescriptions.

So the bottom line here is there isn’t one.

One of the most important measurements accomplished in a PD patient’s monthly labs is the phosphorus finding. My dialysis team looks at all of the results, but concentrates on Kt/V, calcium, A1C, potassium, and phosphorous, at least seemingly. Since my past phosphorous reading was too high, I have been concentrating on getting it back down. As part of this effort, I asked Perplexity what foods I should be avoiding with the following results. Read and Heed! (The lead picture from Poe is its rendition of the element Phosphorous.)

For patients on peritoneal dialysis, it’s important to limit phosphorus intake as the treatment may not remove enough phosphorus from the body. Here are some high-phosphorus foods to avoid or limit:

1. Dairy products: Milk, cheese, yogurt, ice cream, and pudding
2. Processed and packaged foods: Lunch meats, canned iced teas, and bottled beverages with phosphate additives
3. Cola and dark sodas
4. Nuts and peanut butter
5. Dried beans and lentils
6. Whole grains: Brown rice, oat bran muffins
7. Chocolate and caramel candies
8. Organ meats: Liver, sweetbreads
9. Fish roe and sardines
10. Beer and ale
11. Processed meats: Hot dogs, bacon, sausage
12. Pizza

When reading food labels, look for ingredients containing “phos” to identify hidden phosphorus additives. Choose alternatives like rice milk, almond milk, white rice, and fresh fruits and vegetables. It’s crucial to work with a kidney dietitian to develop a personalized meal plan that balances nutrient needs while controlling phosphorus levels.

One of the most often questions patients new to peritoneal dialysis have is “What is involved in the stowing of the many parts required to conduct dialysis?” In that yesterday we received our monthly bits and bobs supply from Fresenius, I thought it might be lucrative to video just what the situation entails. See below: