How to determine Solution Volume for patients

[CHeatherS]

Hi guys and gals.  I am new to the forum, and have only been on home PD for a week, whew.  So many questions.   For now, I am wondering how they determine the volume a person would take to fill.  I am sure weight and hight matters, but what if you have giant PKD kidneys and liver filling your abdomen.  My gosh, I feel like I am stretching my belly out so much.  It's hard to feel anything but pressure.  Who knows if one is hungry, thirsty, have to go potty when you feel like you have been blown up like a beach ball?  I am wondering if there is a chance they are given me WAY too much, or if I just need to be patient and get used to this.  GAH! 

Thanks
Heather

[jeannea]

Probably some of each. Yes it takes some getting used to. But you shouldn't be majorly uncomfortable. Discuss it with your nurse and see if you can try a different volume or if they really feel you need that much. Also you may have to do a kt/v test to see if it's working well and if you have leeway to change. I'm only 5 ft tall and not too fat so my fill is 1500 mL. I know a lot of people get more.

[paul.karen]

The pressure you feel should go away after time.  Your body will get use to all the fluid that it is not use to yet.

As for what strength to use and how much UF to pull off differs from patient to patient.

I was started on yellow bags and stayed on them for months.  My uf was about 500 a night.  I decided to try green bags to see what the difference was.  Using green bags i now pull off about 1500UF a night which seems to be much better then 500UF.
I learned if i used green bags for about a week in a row i would start to get leg cramps. This along with weighing myself nightly has led me to be able to know to use two greens or one green one yellow ect ect.  it is kinda trail and error. 
I also still produce alot of urine.

Once you get your KT/V your neph should be able to give you an idea of what your UF should be.  But remember it is your body and in the end you should be able to manage your own nightly dialysis needs.  If i had never tried green bags on my own i still may only be taking off 500UF  when in truth i feel much better taking off the 1500UF.

Have you had a KT/V yet?  this tells the neph how well your body is dialyzing.  This is where they can adjust how much of a fill you need or maybe if you have good numbers/clearance he could even let you fill less.  My numbers started to go down so he had me use even more fluid which has leveled off my numbers to where we all fell they should be.

I dont have much room to add more  fluid if my numbers start to go low again so if this happens i will likely have to do a fill during the day which im trying to prevent cause i still work and if im full i have a higher chance of having a hernia while lifting certain things at work that are to heavy.

For now im doing 2300ml fills 6x a night with a dwell of about 1:20 mins.  No last fill.

[*kana*]

When I still had my PKD kidneys I would fill with 2500.  Then after a few months I was increased to 3000.  My kidneys were very very large and I lost about 15#'s after they were taken out.

You will get used to the feeling of the extra fluid after a few weeks.  I now have a Hernia and only fill 2850 at night on the cycler.   

[CHeatherS]

Wow, thanks so much for your experience!   It really helps.

I am only a week or two at this, and have been on my own for all but the first few days.  At first I was getting very dry, and found that I couldn't use the green, so have only been using the yellow.  I have not had the KT/V  and not real sure how it works, of course.  I am wondering if the amount of fluid that they take off is what is important, or how much urea and waste.  How do they determine that.  For me,  I don't mind peeing, as I can with my PKD kidneys, but with all of this fluid, I don't feel thirsty and have hardly NO urine. 

I have found that I am so uncomfortable with the full 2500 mL that my bladder is pressured (even though I can't pee) and I have a hard time breathing because my diaphragm is crowded.  I am 5'8" (or less) and weigh 150 with big kidneys and liver.  So I have dropped 500 mL from my fill, and hope that no one has a cow when I tell them.  It makes all the difference in the world.  Until I can get a good night's sleep, (going on 7 days now with no sleep) I need to be comfortable.

Thanks again all... what an adventure, but no way out of it, gah!

Heather

[mykey711]

I use systolic blood pressure (the first number) to pretty much decide.  Over 130, I use 2.5% Green bags . Under 130, I use 1.5%. Over 150, I use 4.5% bags (red bags). I haven't had to use those yet. I get more UF with the high bags, but these can dry you out. Often I'll use one of each, depending on BP and how iI feel.