Need some suggestions

[silverhead]

Sharon's one working kidney is declining in output and she is getting into an overload of fluid, notice it a lot in her ankles and she is having problems laying down because of the fluid, we know we have to be aggressive in removing the excess but so far it seems to be really slow in seeing any progress. Here is what we are currently running on the NxStage:
20 L Dyalisate
1.5 liter removal of fluid (.85 first hour, then .5 till end of run)
system setting 38 is set to "1", meaning it removes the 250 rinse back first before counting down on regular fluid request
450 blood pump speed
Dyalisate rate at 7.2 per hour on .85 period, then 7.6 on the .5 period

Todays run went fine, she did not eat or drink anything during the treatment, but when she weighed in afterward she was only down 1.0 kilo.
I called tech support and he said that that was within the tolerance of the machines operation.
I really want to get more off of her and the sooner the better but have to work within her capacity, the day before I tried running 2 hours straight at a rate of .85 removal per hour but she really had a bad headache hit at the end of the second hour, thats why I backed off the second hour this time, but had the poor removal at the end, do you think extending her treatment time and slower removal or should I try using 25L of Dyalisate and getting the extended time that way?
By the way her treatment time today was 2:40
I'm sure I have forgotten something or if you need more info, ask away. Thanks
Tom

[jbeany]

Do you always remove the same amount of fluid?  My UF goal varies every day, depending on my weight.  I know my scale isn't entirely accurate, so I tend to set it high, and then stop if my blood pressure drops too much.  I usually can tell if it's dropping in plenty of time to change the treatment parameters, so I don't crash much at all.

I find that the higher the rate of UF, the more the machine takes off at a time - over and above what it is set for.  Lower rates, like .5, seem to take off less than it is set for.  If I only have .5 or .6 to take off, I will set the machine to take it all in the first hour, or actually set the goal higher, like .8 or .9 - otherwise I end to far over my dry weight.

Have you tried anything else?  Running above .5 in the last hour gives her a headache, but what about running more than .85 during the first hour?  Try running at 1.0 and then switch to .5?

[Meinuk]

Have you ever tried a 30L run?  I would run 20L on weekdays and 30L on weekends, taking off between 1.5 and 2.0.  There have been some studies about fluid removal, and the time that it takes for our body fluid to move between chambers (Blood, interstitium and Cellls) Bill blogged about it here http://www.billpeckham.com/from_the_sharp_end_of_the/2007/12/dr-agar-on-flui.html

Essentially, my understanding is that taking off too much from your blood, will just dehydrate you, the remainder of the fluid in your body needs time to move between cells and interstitum to the blood, where dialysis has access to it.  So, longer is better.

I could never bring myself to do extend (8 hour) but I could bear 30L (3:45 @ 450 with a FF of 32) 

I hope that you find a solution Tom, you were a big help to me when I was just starting on Nxstage (Jbeany, you too!)



Edited: Fixed url tag error - okarol/admin

[Wallyz]

Tom, ask Jolene about extended over night therapy. It sounds like your wife is not taking enough water off.

[silverhead]

Thanks for the replies folks, I have been doing some of the suggestions,  the last 2 runs and had these results:
yesterday ran at 1.8  removal quest, rate at .85 for 90 minutes, then down to .7 till goal reached about 25 minutes before end of treatment, she took off 2 kilo's. Today did the same with a quest of 1.6 removal and she was down 2.3K at the end. the edema is looking a bit better and she was able to tilt the recliner all the way back and slept better, so progress is being made, but of course I want to see it all off at once and realize that cannot be accomplished, but want her better .......