peeing function

[Riki]

Riki, I think it is really odd that your doctors aren't more curious about what caused the scarring in your transplanted kidneys.  That's just intellectually lazy. 

You'd have to know my Neph.. I think he'd rather be out riding his motorcycle and buying sweaters from my mom than actually looking after his patients.  He STOPPED clinic visits for HD patients because he or his partner will be in the unit at least once every 2 weeks, but if you have questions and you don't want the world to know, you can't ask, cuz everyone else in the room will hear.

Something else about that setup I don't like.  You never know which day they're going to show, so you can't be prepared to ask questions.  I always thought that was what clinic visits were for, so you could have your prepared list, and have a private conversation about your treatment.  I guess he doesn't think we need it.

[RightSide]

You're right, "genetic" doesn't necessarily mean "hereditary."  It could be a mutation too.

Could our great-great-great-grandparents have had those genes, and we inherited them in that random reshuffling of genes when our parents conceived us?  It's possible.  Remember that in the 19th century, many folks died of infections or other illnesses long before their kidneys would have failed.  So we'll never know if they would have gotten kidney disease, had they lived longer.

And in my case, I will never know just what diseases my ancestors died of.  Thanks to two fellows named Hitler and Stalin, all of my ancestors who remained behind in Russia were murdered, and their graves destroyed.  My geneology from before my grandparents immigrated to America was wiped out.

[mogee]

It all depends on what kind of kidney disease you have as to how fast your output tails off.

But there is also another issue which I have mentioned before. How big a part does fluid removal by dialysis contribute to accelerating the deterioration of the kidneys' remaining ability to naturally remove fluid from the blood?

Whether to remove fluid or not is based on an extremely flawed method of ascertaining so called 'Dry Weight'. It is flawed because it does not take into account the possibilities of increased or decreased bodyweight from D Session to session and weight of clothing which will inevitably also vary. Dry weight assessment is treated as an absolute and not the vague approximation that it so obviously is.

The consequence of all this is that many patients have fluid removed sometimes quite needlessly and remember that for every dialysis session involving UF removal a strain is put on the heart resulting in long term cardiac problems and a quicker deterioration of urine output than would be the case if left to natural causes related to kidney failure.

It is my belief that there are many patients who present good urine outputs who should not be having fluid removed in  any way shape or form but are routinely pressured into doing so. There is a sort of 'Guilty until proved innocent' Kangaroo court mentality about whether or not the patient is carrying extra fluid as such the verdict is always 'Guilty!'

I say to anyone first starting dialysis that if you are aware that your urine output has not decreased in any way then resist the attempts of the staff who will insist on removing fluid from the first session onwards.

While they are 'Experimenting' with fluid removal to establish your 'Dry weight' they are actually gambling with your health as a wrong assessment in UF removal can drastically lower your BP or much worse cause a cardiac arrest.

Instead insist on a slow period of assessment which does not involve fluid removal. Maybe a week or two weeks to see how your weight may or may not fluctuate then make the decision yourself.

Most people, as they approach ESRD, suffer from hypertension and edema.  These are clear signs of fluid overload and ought to be addressed with a suitable volume of UF.  Finding an individual's dry weight is a matter of trial and error; the correct dry weight is achieved when the individual's BP is optimised.  I don't believe there is a good reason to preserve the ability to urinate, especially if it means living with hypertension and edema.  There are no permanent consequences associated with the loss of ability to urinate, as any transplant recipient can attest.

It is important to try to weigh yourself with the same amount of clothing prior to each D.  Changes in dry body weight will be reflected in BP.  Blood pressure will rise with weight loss and fall with weight gain unless the target weight is adjusted correctly.

[RenalSurvivorDotCA]

I always thought it was because the machine took over extracting the fluid from your body.as your kidneys give up the ghost. In my case, it not the kidney loss I'm going to miss...they were buggered anyway...but I will miss having a good long satisfying pee. At least that gave me the feeling it was useful for something.

This is what I was told as well. Once dialysis removes the fluid and toxins for you, your kidneys get "lazy" (my unit's term) and stop functioning because the load on them is removed. I don't pee at all; useful on road trips.   

I do still get the sensation once in a while that my bladder is full an I'm going to explode if I don't get to a bathroom. And when I do, it's just a few drops. Funny, I know it can't happen but still can't not go to a bathroom in case I do gush a torrent like it feels I need to.

[Riki]

I get that feeling too, but I ignore it cuz I know nothing is going to come out.  I just figure it's my bladder letting me know that it's still there.. *G*

[Ken Shelmerdine]

It all depends on what kind of kidney disease you have as to how fast your output tails off.

But there is also another issue which I have mentioned before. How big a part does fluid removal by dialysis contribute to accelerating the deterioration of the kidneys' remaining ability to naturally remove fluid from the blood?

Whether to remove fluid or not is based on an extremely flawed method of ascertaining so called 'Dry Weight'. It is flawed because it does not take into account the possibilities of increased or decreased bodyweight from D Session to session and weight of clothing which will inevitably also vary. Dry weight assessment is treated as an absolute and not the vague approximation that it so obviously is.

The consequence of all this is that many patients have fluid removed sometimes quite needlessly and remember that for every dialysis session involving UF removal a strain is put on the heart resulting in long term cardiac problems and a quicker deterioration of urine output than would be the case if left to natural causes related to kidney failure.

It is my belief that there are many patients who present good urine outputs who should not be having fluid removed in  any way shape or form but are routinely pressured into doing so. There is a sort of 'Guilty until proved innocent' Kangaroo court mentality about whether or not the patient is carrying extra fluid as such the verdict is always 'Guilty!'

I say to anyone first starting dialysis that if you are aware that your urine output has not decreased in any way then resist the attempts of the staff who will insist on removing fluid from the first session onwards.

While they are 'Experimenting' with fluid removal to establish your 'Dry weight' they are actually gambling with your health as a wrong assessment in UF removal can drastically lower your BP or much worse cause a cardiac arrest.

Instead insist on a slow period of assessment which does not involve fluid removal. Maybe a week or two weeks to see how your weight may or may not fluctuate then make the decision yourself.

Most people, as they approach ESRD, suffer from hypertension and edema.  These are clear signs of fluid overload and ought to be addressed with a suitable volume of UF.  Finding an individual's dry weight is a matter of trial and error; the correct dry weight is achieved when the individual's BP is optimised.  I don't believe there is a good reason to preserve the ability to urinate, especially if it means living with hypertension and edema.  There are no permanent consequences associated with the loss of ability to urinate, as any transplant recipient can attest.

It is important to try to weigh yourself with the same amount of clothing prior to each D.  Changes in dry body weight will be reflected in BP.  Blood pressure will rise with weight loss and fall with weight gain unless the target weight is adjusted correctly.

Mogee
Here are my anwers to your post.

Most people, as they approach ESRD, suffer from hypertension and edema

There are also people such as myself with only mild hypertension which is medication controlled and do not present with edema. Why should we have to go through a period of adverse events during dialysis which puts a tremendous strain on the heart just to comply with an unnecessary haphazard system of addressing dry weight when there are other processes available which equate  measurement of bodyweight against overall weight which would give an accurate assessment far quicker than making us go through hell for a few weeks.   


Finding an individual's dry weight is a matter of trial and error.

Yes it certainly is and therein lies the scandal. There would be far less trial and error if the above suggestions were to be adopted.

I don't believe there is a good reason to preserve the ability to urinate, especially if it means living with hypertension and edema.

This is a contradiction in terms. Notwithstanding other possible non kidney related conditions How on earth can a patient with full urine output be edemic!? There is every reason to preserve the ability to urinate as every patient who has full output will attest to. One of the most debilitating conditions in ESRD is fluid overload. And who in god's name wants a fluid restriction sooner rather than later?

Changes in dry body weight will be reflected in BP.  Blood pressure will rise with weight loss and fall with weight gain unless the target weight is adjusted correctly.

Again this only applies to partially or fully impaired urine output. Fluctuation in BP cannot be used as a fluid retention indicator when full output is present.

Finally I myself have been on Haemo nearly two years now. Right from the start I had educated myself (thanks to forums like IHD) enough to know that I did not need fluid removal and have always had a zero UF setting on the dialysis machine. My general health and energy levels are good and my bloods are within normal levels apart from the occasional peaks in potassium.

There must be other patients like me who maybe don't know enough about their conditions to confidently challenge the current orthodoxy which because the majority of ESRD patients are fluid retentive routinely ignores the possibility that some are not and yet those patients still have to go through the suck it and see process which doesn't care a damn about respecting people's desire to preserve precious residual function for as long as possible

[needlephobic]

I am still peeing alot at the center they don't take anything off. I have gone 6 days with out D and felt pretty good alittle tired but take a nap and I am going good again. So it makes me wonder how bad my kidneys are? The Neph says both kidneys are running at 2%  thats a total of 4% I don't think that is right and really can't trust what he says anyway.

Needlephobic why have you gone 6 days without Dialysis. Is that your own decision or your clinic's. I too do not have any UF taken off as after having been on dialysis for 4 years my output has never reduced even though my GFR is 6%.

at that time i did that was having probs with the charge nurse and they did nothing so took it upon myself to go when she wasn't there. Like i said was alittle tired but after nap i was good to go and still could do it. I believe I could do 2 D treatments a week and be ok right now if the tech can get a clue and not remove fluids i wouldn't be sick have the time. I still say my kidneys are doing better than what the neph says. We all know our bodies better than the neph and i say my kidneys are functioning more that 2% and i will find out if my hunch is true   

[chook]

Hmmm, lots to think about after reading all this. My D nurse wants me to pull off more - and I still pee a fair bit. I'm on PD and usually take off 400-600mls per night extra. Now I'm running a stronger bag twice a week and pulling off over a litre on those nights but it's not affecting my weight. So I'm just confused. I do get a little puffiness around my ankles occasionally but no real swelling. I have no fluid or dietary restrictions ATM. So will increasing D decrease my remaining kidney function? Now my brain is really working overtime.

[texasstyle]

Chook, even though you are on no restrictions you said you do have a little swelling around your ankles. From what I do understand (and that's not saying a whole lot lol), you probably still want to be careful especially with your sodium. Sodium (salts) will hold fluid in like a sponge. I'm thinking it is good for anyone to watch this with your diet in general including myself. There is so much salts in the foods we eat. Many times we don't even realize it.

[chook]

Thanks, Texasstyle - I do try and watch my salt intake and don't add it regularly to my cooking or food BUT I do love potato crisps and savoury biscuits and bacon!!! Luckily I live a long way from the shops so only buy a small amount and when that's gone, I'm good again for a while

[Riki]

I was on PD for 4 and a half years, and I never had a negative UF.  There were times when I knew I had too much fluid on, cuz I could feel it, and I went with a stronger solution. if you're taking off more than 500mls extra a night, I don't see a reason to go any stronger unless you've got extra fluid on.  AND you really have to cut out the salty stuff while on PD.  Since you're always carrying extra fluid, if you eat a lot of salty foods (and a lot of processed food is incredibly salty), you're going to retain that fluid that's supposed to come out when you drain.  Even if you don't see it, there may be extra fluid in there.  It could be accumulating around your heart and lungs.  If you get winded easily when walking, that's probably where that extra fluid is.

I had stopped peeing before I started HD, so I really needed to lose the fluid.  I don't think they tried to take anything off while I was in the hospital for those two weeks, as I was still pretty sick from the peritonitis.  My legs were swollen to nearly twice their size, and I could barely walk.  Once I was home, I think it took the nurses about 2 weeks to get all that extra fluid off, and I no longer needed a walker to get around.

I'm not fluid restricted, and haven't been since I was a child.  I'm thinking that as an adult, they think I'm responsible enough to know when too much is too much, although I do overdo it sometimes.  I try to watch how much I'm taking in, since I do not have any output, and for the most part, I do ok.  My dry weight has actually been lowered in the last week, because my bp has been rather high, and a couple of times I came off below my dry weight anyway, with no adverse effects.

[chook]

Thanks for the info, Riki. Will be more enquiring in future about increasing bag strength. Thankfully I am not breathless and remain fairly active.

[Riki]

I just remembered something, and it's kind of related.  When I was watching Keith Olbermann tonight, there was a commercial, but I don't remember what it was for.  The slogan was "rediscover the go" and my first thought to that was, "that's what transplant patients do."  *L*

I laughed so hard.  I'm sure Mom thought I'd finally lost it.

[khaliq282]

hi i  have esrd, but my pee fuction is ok like normal,
kidney bassic work is clean blood nd produce waste products in urine.
in body a subtance name  SERUM ALBUMIN ,its work n  body to make pee.its normal range 35 to 50 gl.
if u have peresent normal range n body u can pee normal,no matter what type of kidney diseas u have.
my serum albunim leavel is 48.

[Ken Shelmerdine]

hi i  have esrd, but my pee fuction is ok like normal,
kidney bassic work is clean blood nd produce waste products in urine.
in body a subtance name  SERUM ALBUMIN ,its work n  body to make pee.its normal range 35 to 50 gl.
if u have peresent normal range n body u can pee normal,no matter what type of kidney diseas u have.
my serum albunim leavel is 48.

Please can I appeal to a moderator about the quoted text above as some of it is in textspeak which I know many people understand but I myself find quite difficult to read spontaneously. I do not wish to offend Khaliq but please can we at least maintain standard English which by definition is understandable to all.  Thank you

[khaliq282]

Ken sorry i have some english writting habbit to short.that i explaind already in my other post.i will try to mantian standerd english.i thanks you all with all my heart.

[Ken Shelmerdine]

Ken sorry i have some english writting habbit to short.that i explaind already in my other post.i will try to mantian standerd english.i thanks you all with all my heart.

Khaliq please accept my sincere apologies as I didn't realise that English wasn't your first language. There have been instances on this forum when you see a post in plain English from someone and then on another post that same person will revert to textspeak. I realise now that you are not guilty of that and you are trying hard as you can to use English to the best of your ability. So sorry for misunderstanding you.