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Peritoneal Dialysis Labs: An In-Depth Overview

February 6, 2023 / Henry Feeser / 0 Comments

On Monday 2/6/2023 I am scheduled to have my monthly lab work done at Fresenius Medical Center in Granbury, TX. I thought it would be appropriate to blog about what these tests are all about in a general nature, followed by more specifics of my personal results. So here goes:

Peritoneal dialysis (PD) is a form of renal replacement therapy that is used to treat patients with end-stage renal disease. It involves the use of the patient’s own peritoneal membrane, which is the inner lining of the abdominal cavity, as a filter to remove waste products from the blood. This process is performed through a series of exchanges that are done several times a day, typically at home. For me, I do four exchanges or two hours duration each.

One of the critical components of PD is the use of dialysis solution, which is a sterile solution that is instilled into the peritoneal cavity through a catheter. This solution works by drawing waste products from the blood into the peritoneal cavity, where they are then removed during the next exchange. To ensure the safety and efficacy of the dialysis process, it is essential to regularly monitor the dialysis solution and the patient’s response to it. This is where peritoneal dialysis labs come in.

What are Peritoneal Dialysis Labs?

Peritoneal dialysis labs are specialized facilities that are designed to monitor and evaluate the quality of the dialysis solution and the patient’s response to it. These labs typically use state-of-the-art equipment and technology to perform a series of tests that help to assess the concentration of waste products, electrolytes, glucose, and other important parameters in the dialysis solution and patient’s blood. For me, Fresenius uses spectra laboratories out of Southaven, MS to conduct the labs. At least that’s the letterhead on my lab reports.

The main objective of peritoneal dialysis labs is to ensure that the dialysis solution used in PD is both safe and effective. To achieve this, they perform several key tests, including:

Dialysis Solution Glucose Concentration Test: This test measures the concentration of glucose in the dialysis solution, which is critical to the success of PD. If the glucose concentration is too high or too low, it can affect the efficiency of the dialysis process and cause adverse effects such as hypoglycemia or hyperglycemia.
Peritoneal Equilibration Test (PET): The PET test measures the rate of transfer of glucose and other solutes between the blood and dialysis solution. This test helps to determine the effectiveness of the dialysis solution and the patient’s peritoneal membrane.
Dialysis Solution Electrolyte Concentration Test: This test measures the concentration of electrolytes in the dialysis solution, including sodium, potassium, and calcium. It is important to maintain a proper balance of these electrolytes to ensure the safety and efficacy of PD.
Bacterial Culture Test: This test is performed to assess the presence of bacteria in the dialysis solution. Bacterial contamination of the dialysis solution can cause severe infections, and regular monitoring is critical to prevent this from happening.

The results of these tests are used to adjust the dialysis solution and the patient’s treatment plan, ensuring that the PD process is both safe and effective.

Benefits of Regular Monitoring by Peritoneal Dialysis Labs

Improved patient outcomes: Regular monitoring of the dialysis solution and the patient’s response to it helps to ensure that the PD process is effective and that the patient is receiving the best possible care. This, in turn, leads to improved patient outcomes, including better control of waste product levels, improved electrolyte balance, and a reduced risk of infections.
Increased patient comfort: Regular monitoring helps to identify and address any issues or adverse effects that may be affecting the patient’s comfort and well-being. This helps to improve the overall quality of life for patients undergoing PD.
Improved safety: Regular monitoring by peritoneal dialysis labs helps to ensure that the dialysis solution is used.

In a following blog we’ll discuss my actual labs, what they mean to me, and how I respond to them if at all.

Using the LIBRE 3 for Glucose Control While On Dialysis

February 3, 2023 / Henry Feeser / 0 Comments

We laid out the need for continuous tight diabetic control both before and subsequent to going on dialysis in previous blogs. While a pain in the rear, it is something that diabetics in general, and those with DKD (Diabetic Kidney Disease) MUST deal with.

In general, there are two ways to ascertain one’s degree of diabetic control, either via pricking the skin, gathering a blood sample with a test strip, and reading the resulting glucose with a device. Of course you could go to a lab, have blood drawn, and receive standardized results in a few days.

The second and more recent methodology is via a CGM (Continuous Glucose Monitor.) Yesterday I blogged about a third emerging methodology embedded in watches. I am currently using the Libre 3 Freestyle by Abbott and a watch. It is a follow on to their Libre 2 system which I also used for three months and is a vast improvement in many ways. BTW, Libre comes from the Latin word līber, via the French and Spanish libre; it shares that root with liberty. It denotes “the state of being free”, in the sense of “having freedom” or “liberty”. I’m certain in a marketing sense the word Libre somehow applies herein.

The Libre 3 system is more accurate, does not require an external reader, has an improved app, provides more or less continuous readings, and also provides a form of A1c readings named GMI (Glucose Management Indicator in mmol/mol%) as compared to its predecessor. It is night and day superior to finger pricks. While this is not a sales pitch for this system, it should be recognized that there are several competing products available; I’m just hands-on with the Libre. A quick Google will extoll its virtues for those interested.

Following are some screenshots of what I consider to be useful from Libre3. I use it daily, probably at least six times a day to check my glucose levels. It is often surprising how the body reacts from a glucose viewpoint to the intake of food and beverages and exercise. Just getting up in the morning results in a rising glucose level. It should also be noted that I pay for the Libre 3 system out-of-pocket. Since I take insulin only once a day, currently 8 units of Lantus, I am not eligible for ANY insurance support be it Medicare, Tricare For Life, or VA. It is costing me roughly $210/month for two senders which last 14 days per sender. To me it is more than worth the cost.

The Case for Strong Diabetic Control Before and While On Dialysis Using the E400 Smart Watch

February 2, 2023 / Henry Feeser / 0 Comments

A strong case has been made in a preponderance of reviewed medical journals that diabetes is the primary and number one predictor of a future requirement to go on dialysis. See stats in the table below from CDC here: The extreme need for close diabetic control does not end once a person goes on dialysis; if anything, because PD at a minimum requires dumping a sugar solution into one’s stomach, it becomes even more critical.

For adults with diagnosed diabetes:
- 69% had high blood pressure, and 44% had high cholesterol.
- 39% had chronic kidney disease, and 12% reported having vision impairment or blindness.
- Diabetes was highest among Black and Hispanic/Latino adults, in both men and women.

This blog is not about the how-to of diabetic control, but about one of the new tools just hitting the market to ascertain the degree of control, that is, how is my “blood sugar/glucose doing?”

Coming out of China is a new class of wearable devices in the form of a wristwatch at a very reasonable price called smart watches, or bio watches. They are generally available from Temu.com/App, Aliexpress.com, etc. for about $40.00. I have purchased two from Temu.com via their App for $39.62. See the Graphic below for all they are purported to be able to measure from here: The watches are based on the GR5515 chip and are Model E400 from Vanssa in China. Scroll down this link for more info on all the watch purports to do:

I have been using the watch’s many functions in parallel with my go-to standard blood pressure, O2, temperature, and glucose (I use the Libre 3 CGM) as comparisons. I find some of the readings to be right on, and others to be somewhat consistent. It should be pointed out that the documentation that comes with the device explicitly states they are NOT to be used for medical purposes – yet I might add. As the video describes below, they are great for trends. I have found the E400 watch to be a great addition to a bag of tools for the diabetic/person on dialysis used in conjunction with the associated H Band App. Please watch the video embedded below for an independent review of the E400.

My next blog will discuss using the Libre 3 CGM for diabetic control while on dialysis.

Helpful Dialysis App plus Supply Admin

February 1, 2023 / Henry Feeser / 0 Comments

Today’s blog is about several actions taken this morning. First, it is Wednesday, so I needed to replenish my Ready Service Locker (RSL) with a week’s worth of Cycler dialysate bags and cassettes. From our bulk storage in our spare bedroom closet, I moved 7 cassettes, a 4-container box of 1.5% dialysate, a 4-container box of 2.5% dialysate, and 4 boxes of 2 in each box of 5 L 1.5% dialysate. See the photo below. I had already stowed one box of the 5 L dialysate when I took the photo.

Fresenius Medical provides an adequate albeit somewhat slow App named “PatientHub” for PD patients to use to communicate with their teams, order supplies, enter biometric information, and a host of other activities. I recently reported that the Hub->Menu->Vitals Graphs path was not working. Furthermore, I received guidance from a Fresenius Rep that it only worked if you entered your biometric data into the app itself. Additionally, I came to find out that my team members rely on biometric data being entered into the Cycler which is then also entered into the USB drive inserted into the Cycler which I sneaker-net into the team periodically. If I did not enter data into the Cycler, my team would not receive the data. If I do not enter the data into the app the Vitials Graph function is inop. I figured out a way to solve this dilemma via the app by lying to it that I had not entered any data into the Cycler although I had, which brought up a biometric data entry screen into which I entered data daily. It worked and now the Vitals Graphs portion of the App is useful – to some extent. Below are examples of the App itself on my S20 Samsung phone, the data entry screen, and screenshots of the data graphs, with the timeframe set to 7 days. A 30-day option is also available. I also used the App to order supplies this morning.

7-day Glucose AM glucose readings upon rising

Tomorrow we’ll journey back to the diabetic side of PD and discuss the tools I use to monitor my Glucose levels and also A1c levels. Stay tuned.

Diabetes and Dialysis: What You Need to Know

January 31, 2023 / Henry Feeser / 0 Comments

Diabetes is a serious health condition that affects millions of people worldwide. For those with diabetes, managing the disease can be a complex and challenging task. For those with diabetes and end-stage renal disease (ESRD), dialysis can be an essential part of their care. In this blog, we’ll discuss the connection between diabetes and dialysis, and what patients need to know to stay safe and healthy.

Diabetes can cause a number of complications that can lead to the need for dialysis, including hypertension, heart disease, and nephropathy. (I have all three, having gone through a triple bypass in 2015.) Nephropathy, or kidney disease, is a major complication of diabetes and can cause ESRD. When ESRD occurs, dialysis is necessary to keep the patient alive.

I was first diagnosed as a diabetic in the early nineties via a glucose tolerance test while on active duty in the Navy. I was first diagnosed with the real possibility of Chronic Kidney Failure in the early 2000 timeframe. My diabetic condition progressed from control with diet and exercise to oral meds to insulin plus oral meds until the present day. Same with ESRD only doctors just stated “we’ll watch it.” What they meant was it was going to happen and we’ll just watch it happen. For me, diabetes and dialysis have been a fact of life, that is sooner or later…….

There are two types of dialysis that may be used for those with diabetes: hemodialysis and peritoneal dialysis. The general populace is often confused by this distinction, thinking only that one goes to a dialysis center three times a week for a couple of hours. Hemodialysis involves using a dialysis machine to filter the blood outside of the body. I underwent hemo as it is called for about six weeks while I was getting set up and moving through the queue for peritoneal dialysis aka PD. It is miserable and time-consuming, and a cold experience wipes you out, and I wouldn’t wish it on anybody including my worse enemies (if I had any which I don’t.)

“Although the ancient Egyptians were the first to describe the peritoneal cavity in approximately 3000 BC, the concept of peritoneal dialysis is relatively new. In the late 19th century, Wegner, a German investigator, was the first to use peritoneal solutions in animals.” From here: The solution used is called dextrose dialysate, or dextrose, or more formally dialysate.

What I use is a 1.5% or 2.5% Dextrose solution of Hydrous Dextrose, Sodium Chloride, Sodium Lactate, Calcium Chloride, Magnesium Chloride, and water. 8000 mL or 8 liters of this fluid is pumped into my Peritoneal cavity via a catheter in my stomach 2 liters at a time. When filled it remains there for two hours (dwell) and then is pumped back out (drain.) This takes place four times every night, seven days a week. This is all controlled by the Liberty Cycler apparatus.

Ideally, the drain takes place at 100ml per minute, or 20 minutes for the entire individual drain process. If you add up four dwell periods of two hours each, and four drains at a minimum of 20 minutes each (this rarely happens in this short a timeframe), you end up with eight hours of dwell, and 80 minutes or one hour and 20 minutes of the drain, for a total time on dialysis ideally of nine hours and 20 minutes. This NEVER NEVER happens. With me, it is more like 10 hours and thirty minutes every night. Add to this setup and tear-down times and you can see that PD requires lots of time to accomplish.

Dialysis is not a walk in the park, but short of a kidney transplant, there are no other solutions currently available. I did read that research into using printed kidneys is currently underway. Sign me up. In a follow-up blog, I intend to discuss in more depth the diabetic side of the diabetic dialysis balance.

While on Dialysis: Do the things you love!

January 30, 2023 / Henry Feeser / 0 Comments

INC ran an article that explored what gives people the greatest happiness in life. The article suggests “Do the things you love” is central to happiness in life. That got me thinking about how the concept applies to my situation – being on Peritoneal Dialysis and by extension readers of this blog who are also being provided life support via dialysis.

How can we, with the constraints of dialysis, “Do the things we love?” I have found dialysis treatment does not, at least for the most part, affect my life to any great extent so far. Travel is an exception requiring more preplanning and effort.

So what things am I doing that I love while on dialysis?

It’s winter in North Texas so I’m planning for Spring gardening. Looking at Burpee’s seed catalog. Reviewing what went well last year and not so well.
The Rolex 24 Race has just been conducted this past weekend. As an ex-Porsche racer, I enjoy the racing season starting up again
My wife and I are always looking for new food to prepare at home new dishes and new tastes. Yesterday we prepared a couple of filet mignon steaks by first searing them in an iron skillet, then finished cooking them in the same skillet in the oven and topped them with homemade herb butter. We found them to be superior to any we had had anywhere in the world previously.
The deer here in our locale Pecan Plantation have been breeding and laying down for the night in our yard. Always a satisfactory sight to behold.
I enjoy writing this blog and learning more about the ins and outs of dialysis. There is no straight and narrow path I’m beginning to ascertain.
As an engineer, I’m very interested in the rollout of AI-based tools for writing, art, and composition and am exploring Chat in its various forms as we speak. Also, art apps. In the short term, I plan on investing in AI startups when it becomes financially prudent to do so.
We have a seven-month-old Golden Retriever named Dickens. Seven days a week come rain, shine, sleet, or hale I take him to our Dog Park and also walk him for about ¾ of a mile. Good for him and better for me. My wife walks him at night for ½ hour or so. Training-wise, he is a work in progress so this is a constant challenge. As I write this he is asleep on my left foot – never far away and always in touch. That’s what Goldens do.

Like the Statler Brothers in their popular song “Flowers On the Wall,” don’t tell me I’ve nothing to do!”

The Statler Brothers – Flowers on the Wall – YouTube

Going Back to go Forward: Revisiting Yesterday’s Blog plus Cycler Drain Problems

January 27, 2023 / Henry Feeser / 0 Comments

But first going Forward: a bad night for me and Peritoneal Dialysis. The system would just not drain, regardless of where and how I stood, what dance steps I made or how I held my mouth. The Cycler persisted on sounding its loud “Draining slowly” warning, of course with no reflection on what was causing the slowness. I checked and rechecked both the Drain Line (yellow) and the Blue is You Line to no avail. I removed all tape and fixtures on the Catherer Line, and gently tugged the Catherer Line itself to no avail.

On average over six months, the total time I spend on the Cycler itself is on the order of 10 hrs 30 minutes; last night it approached 11 hrs, an all-time high. For the record, 3/4 nights the Cycler alarms on the Drain Cycle; only 25% of the time do I experience a restful night’s sleep without Drain Alarms.

Expecting that something was just not as it should be, I contacted my PD Nurse at Fresenius. She gracefully agreed to see me as soon as I could get there, some 1/2 hour drive away. Upon arrival at the Fresenius Clinic, she manually drained my PD Access, then added 500 mL of fluid and timed how fast it went in (fill) and how fast it Drained. She then did so with 2000mL. In both cases, specs were exceeded. (She used 100 mL per minute for the drain as the norm, so 20 minutes was the time expected.)

So available tests suggested my PD catheter system is performing to specifications. I am to suit up again tonight with hopefully better results. If not, the next step would be to x-ray my stomach area to ascertain if all is as should be with the catheter interior to my stomach.

BTW, while there I asked about replacing the line on my catheter that leads from the section that actually enters the stomach to the Blue is You connect on the Cycler and was told that this is accomplished every six months as a matter of course. Stand by for updates.

Now an update on how data moves around Fresenius or doesn’t. Clinic personnel do not have a live feed of data coming off the Cycler even though the Cycler has a cellphone-based modem to transmit data. They received stored biometric data when I visit the clinic and bring in the installed USB thumb drive. They can see and respond to any comments I make via the App, but it is unknown how much if any of the other data they can review.

Fresenius is touting a new integration of data sources and support via their Kinexus Therapy Management Platform as being specific to both the Liberty Cycler (the current PD device I’m using) and the new-to-the-world VersiPD system in early beta testing I have previously blogged about. See this link for more information. You may view an embedded video from the above link that is embedded below. It seems to take a few seconds to load – maybe.

The Kinexus rollout suggests Fresenius recognizes they need to improve their data integration efforts and lever up on the data they are by default collecting on patients. I’ll post updates as my understanding in this area improves.

Fresenius Medical PatientHub App; “Feature” not documented

January 26, 2023 / Henry Feeser / 2 Comments

Those employing the Fresenius Liberty Cycler to support their daily home peritoneal dialysis, know that when coming off dialysis in the morning, one of the last Cycler screens requests input of a host of biometric data including weight, blood pressure, pulse, type of dextrose used, last bag type, glucose, etc. On the PatientHub app (I use an Android-based Samsung S20+5G) you are required to input a bunch more data including if you entered your vital signs in the Liberty Cycler, solution information, any manual exchanges, etc. Lots of data.

My first observation is that given that I have been faithfully supplying requested data since starting dialysis on 9/30/2022, not one entity or person from my PD team or anywhere else has ever commented on the same. Not one.

We had a philosophy in the Navy that in the face of too many reporting requirements from desk jockeys, just stop sending them and see if anyone squawks. No squawks, no report, that simple. Perhaps that approach should be used here.

My second observation involved the PatientHub App’s “Features” not being implemented in a meaningful way. When you dig down from the login screen to the landing screen, there is a tab in the upper right corner named “Menu.” A menu choice is “Vital Graphs.” One would assume that some if not all of the data being input across the Fresenius Dialysis spectrum would be graphically presented herein. Such is not the case. For me, only my dry weight is listed which is not of much help in viewing data trends graphically.

I submitted a report to the Fresenius App keeper and received the response below a day later. It is the last graphic below.

From the response, it is clear that the most obvious integration of reporting systems is totally lacking, and apparently not a priority either. This further begs the issue of where all this data is going, who is viewing it, and to what end. I want to know and will be pursuing this “issue” further with Fresenius personnel. Standby. Out. (Screenshots of the App are below:)

Scorebox After Four Months of Peritoneal Dialysis

January 25, 2023 / Henry Feeser / 0 Comments

I have been on Peritoneal Dialysis, supported by the Fresenius Medical Team in Granbury, Texas, for approaching four months. In this blog, I intend to share my experiences, good and not-so-good, thus far.

First, the Good:

I feel great most of the time but get tired toward the day’s end. I am 84 years old, so what? I don’t nap at all. I can still take care of the necessary yard work on our half-acre chunk of paradise and stay up with necessary house repairs, more or less.
I have established a routine for dialysis-related requirements that is effective, efficient, safe, and satisfactory. It includes the Navy Seal credo “Make your bed.”
I can’t overstate the satisfaction of having a routine for taking down, setting up, and using the Peritoneal Dialysis System. In truth, it has become part of my daily life and, by extension, my very existence. Not only is PD keeping me alive, but it is also the reason I’m alive, and as such, is deserving of my full attention. It is not a burden or a crutch but a central component of my life. There is no me without dialysis. We are the same.
Fresenius and Fresenius Team Support are central to my current successful PD. Supply ordering at first seemed to be obtuse but proved to be straightforward. I use the app for ordering. Supplies have always been delivered within the stated window and stowed where we desired. Team meetings occurred as scheduled, and a team member professionally dispelled all my questions and concerns.

The Not-So-Good:

The’s lots of “stuff” to keep in mind with PD. Supplies, the status of, do you have all the expendables you need – tape, gauze, germicidal crème, etc.?
The Cycler throws excessive amounts of errors during the Drain Cycle in particular. Last night, for instance, I had to get up during the first three drain events and stand up to complete the drain cycle for about 10 minutes each, resulting in about half an hour of lost sleep. Drain problems take place on about 8 out of 10 nights. I can’t wait to see how much the new VersiPD improves in this area.

The Ugly:

erectile dysfunction (ED) is very common in men on dialysis—as is sexual dysfunction (difficulty with arousal or orgasm) for women undergoing treatment. I can attest to this from a male perspective.

I am on a fixed four-cycle of two-hour duration each night. What on the surface would appear to be eight hours of dialysis neglects drain times. On average, the PD process for me takes about 10 hours and thirty minutes. The longest is 10 hrs 55 minutes; the shortest is 10 hrs 13 minutes. Not included are setup and tear down times, handling of necessary components, added time to shower because of catheter requirements, and other necessities. When you add all the time requirements, half your day is involved in PD. PD requires a fixed block of time. If you stay up to watch an NFL game, you pay for it on the other side by remaining hooked up to the Cycler later in the morning. There is no way around it. Half your life is devoted to Peritoneal Dialysis in one form or another.
At the start of our dialysis journey, unknowns bugged us. (By us, I mean my wife and me.) We watched YouTube videos on using the Liberty Cycler and had that down before requiring PD, to the degree that I accomplished two weeks of training in four days. The most critical question in our minds, mirrored in Fresenius-sponsored Forums, is how we would deal with all the supplies required to support PD. I have previously blogged on how we deal with this aspect of PD; for us, it’s no big deal.
One of the problems often listed in Forums is the weight of the solutions boxes, the new boxes not having handles like the old ones, and so forth. Yes, the boxes are heavy and difficult to move around easily. I understand how some people regardless of age could find this effort to be challenging, especially when accompanied by the frailty of old age. But should people be denied PD based solely on this? I don’t think so. On a bag-to-bag basis, rather than a box basis, I think most people could cope. An organization such as I use wherein supplies are moved from bulk storage to ready storage next to my Cycler would help I’m certain. Maybe Fresenius could offer this service as part of their package.
erectile dysfunction (ED) is very common in men on dialysis—as is sexual dysfunction (difficulty with arousal or orgasm) for women undergoing treatment. I can attest to this from a male perspective.

Fresenius Medical Care: My Peritoneal Dialysis support company

January 24, 2023 / Henry Feeser / 0 Comments

I have put my very life in the hands of the company providing me PD support, Fresenius Medical Care, ticker symbol FMS. They provide Liberty Cycler equipment, medical support personnel, disposables, monthly supply replenishment, labs, and online support. Quite a mouthful. Given the level of my dependence on FMS, it behooves me to know all that is relevant about this company.

Wiki offers the following insights: Fresenius Medical Care AG & Co. KGaA is a German healthcare company that provides kidney dialysis services through a network of 4,171 outpatient dialysis centers, serving 345,425 patients. The company primarily treats end-stage renal disease (ESRD), which requires patients to undergo dialysis 3 times per week for the rest of their lives (When on hemodialysis – I am on Peritoneal dialysis every night.)

With a global headquarters in Bad Homburg vor der Höhe, Germany, and a North American headquarters in Waltham, Massachusetts, it has a 38% market share of the dialysis market in the United States. It also operates 42 production sites, the largest of which are in the U.S., Germany, and Japan.

The company is 32% owned by Fresenius and, as of 2020, generates around 50% of the group’s revenue.

The company is on the Best Employers List published by Forbes. (Note: Fresenius is #339 on Forbes’s Global 2000 in 2022.)

In December 2022 Helen Giza (54) was appointed Chief Executive Officer of FMS. Helen Giza joined Fresenius Medical Care in 2019 as Chief Financial Officer and took on the additional roles of Deputy CEO and Chief Transformation Officer in 2022 heading the FME25 transformation program. Previously, she was Chief Integration and Divestiture Management Officer at Takeda Pharmaceuticals since 2018. Before joining the Takeda Corporate Executive Team, she served as Chief Financial Officer of Takeda’s U.S. business unit since 2008. Prior to that, she held a number of key international finance and controlling positions, amongst others at TAP Pharmaceuticals and Abbott Laboratories. Helen Giza is a U.K. Chartered Certified Accountant and holds a Master of Business Administration from the Kellogg School of Management at Northwestern University in Evanston, Illinois, USA. From here:

Graphical analysis of FMS from a stock perspective from here is below: