A Video Guide to Hemodiafiltration at Home with the Fresenius 5008 Machine
Hi, I’m Helen, and at age 42 I was diagnosed with end stage renal disease due to IgA nephropathy. To say it came as a shock is an understatement. I was a single parent to a 9 year old and had only just moved house. I was admitted and commenced on urgent haemodialysis (HD) and preparations were made for me to commence APD/cycler (automated peritoneal dialysis).
After 18 months struggling with APD (I only felt well for the first 3 months), I was recommenced on HD to have preparations for an arteriovenous fistula (AVF). I was on maintenance (in centre) dialysis for 5 years, and during this time my health remained unstable due to hypertension. I was admitted to hospital five times in one year at one stage and on several antihypertensives.
Needless to say, the impact on my young daughter was immense. Following much research, I put myself forward to train for home HD, and have never regretted it. I’ve been on home HD since my daughter was 13 and am totally self-reliant: responsible for all my own needling, setting up/stripping down, ordering of supplies etc. We even managed to move house 6 months ago, and I organised having the equipment relocated etc. and avoided having to dialyze in centre. I am happy to say I’ve had no unplanned hospital admissions since being on home HD.
There should be no barrier for those wanting to commence home HD. If I can do it as a single parent and with four crazy cats, I’m sure with a little encouragement, more people will be able to.
I produced these three videos about doing hemodiafiltration (HDF), and hope they will provide info for those who are doing (or thinking of) this modality.
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Introduction and Lining of the Machine (22:13 minutes) https://www.youtube.com/watch?v=I7989ivaE2M
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Setting Up of Dialysis Table and Needle Insertion (37:18 minutes) https://www.youtube.com/watch?v=rut15aUUKPw
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Completion of Treatment, Disconnection, and Needle Removal (16:07 minutes) https://www.youtube.com/watch?v=Npcwb8j7DPc
Comments
jerry howell
Jun 15, 2020 9:46 PM
Dori Schatell
May 15, 2020 7:01 PM
As John points out, hemodiafiltration is relatively rare in the U.S. But, as we are an international group, I think your videos are a terrific addition to the information available for people on dialysis, and will help answer some questions--and likely raise some, too. :-)
John Agar
May 15, 2020 1:57 AM
John Agar
May 15, 2020 1:54 AM
Thank you so much for your video clips. It is always humbling to see how well extraordinary ordinary people master, understand, and derive such benefit from taking dialysis home. I utterly agree – home care, and especially self-care at home, offer the absolutely BEST outcomes for people who need dialysis support.
One issue in your excellent series troubled me though ... you are using a 5008 Fresenius system that offers split mode therapy – it can be set to run either in HD or in HDF mode – and as you are using substitution fluid, it seems clear to me that you are using the system for home HDF ... but ...
My concern is that the majority of patients who access the Home Dialysis Central website and these blogs come from the US, where the use of, the exposure to, and the familiarity with HDF is almost negligible. While my understanding is that at least one of the major US companies has ‘approved’ the use of HDF – whatever ‘approval’ actually means – the uptake/use/understanding of HDF remains still very, very limited.
As such, some US patients may be a little mystified by your references to substitution fluid and your use of a second roller pump, with an “um ... what it that second pump doing?” response. Substitution fluid [aka replacement fluid] introduces a completely new dialytic concept to the dialysis process ... where dialysis (as we think of it) rests primarily with diffusion down a concentration gradient, diafiltration introduces the added dialytic concept of convection driven by a pressure gradient! The two processes are quite different. As 20 or more litres of fluid are ‘sweated’ across the dialysis membrane during dialysis instead of the usual 2-3 litres of ultrafiltrate that is removed in conventional dialysis systems, the exact ‘gap’ [let’s say 20 litres – 3 litres = 17 litres] MUST be replaced back into the circulation DURING dialysis. Not to do this would invite a circulatory catastrophe. I am not sure if this absolutely vital difference quite came across in your excellent Vblogs.
As US readers may not fully be on board with this information, it might be useful to look back at a couple of HDF explanatory blogs on HDF that I wrote for KidneyViews a while back [in December 2015 and January 2016] ... you could copy and paste either or both into your browser to read them:
http://www.homedialysis.org/news-and-research/blog/130-us-haemodiafiltration-where-art-thou
http://www.homedialysis.org/news-and-research/blog/135-explaining-haemodiafiltration-hdf
It may be useful for any who are uncertain about the KEY difference between HD and HDF to read through these two blogs – especially the second of the two.
Thank you so much for your effort providing these Vblogs.
John Agar.