Dialysis removes Fluids and Solids - but how much of each !

[talker]

Any way to know how much,, of what, is removed by dialysis, is fluid , is solids!   
Yes, I know it depends on 'dry weight' as in 'what's your dry weight when you weigh in' and weigh-out . 
For example, if the weigh-out show 1 kg difference from the weigh-in, any way to know which was water / solids? 

talker

[ianch]

in short not really.  Its a guessing game but over time you will start to understand how your body increases and decreases weight and things get more accurate.  For In-centre it can be challenging as doctors don't really know unless its blatantly obvious you are in fluid overload or at risk of crash.  they tend to rely on ankle size, blood pressure, and lung checks, but all of these can be affected by other things as well.  In-centre is also complicated by policy - as you are on machine for minimal time they need to ensure you hit that weight target (correctly or incorrectly) on as many days as possible, as the heart cant handle constant over loading. 

For home hemo its a bit easier because we do more sessions so 500gram short or over is not an issue.  At home you would probably be more aware of weight  - for example I would weight myself every morning and night so I knew how much I could drink or how many meds I needed to take to remove excess.

In summary it takes time to get it right but it does get easier.
 

[obsidianom]

As a doctor I am a beleiver in general that "less is better" . IN OTHER WORDS IF NOT SURE , DO LESS.  Remove less water if not sure as it is less tressful then tking too much in general . Obviously there are some people that need a lot taken off , but if you are otherwise ok then less is better. Its safer to be less agressive . Overtime you begin to se how this works. Sometimes we try to do too much and beat up patients.

[talker]

Thank you ianch and obsidianom,

Is much as my experiences have been.

But was a tuffy getting there.

talker

[ianch]

Absolutely, less fluid removal is key to many important aspects.  I have tested and demonstrated that its possible to reach a target within 2 litres and do it not only safely but with almost no mental or physical effects.

However as a doctor I'm sure you have patients that come in 3 to 4 litres over weight on a regular basis and are forced to employ polices to remove the immediate danger, even though fast removal in itself creates problems - catch 22.   Patients must understand that the first step is to review sodium intake, the next reduce fluid intake, which will aid how the treatment session progresses.     
 
I'm not a supporter of short dialysis daily or otherwise, but accept that daily is better than 12hrs per week. In the end the more hours one does the better the toxin removal and the less fluid per hour is required to be pulled.   

As a doctor I am a beleiver in general that "less is better" . IN OTHER WORDS IF NOT SURE , DO LESS.  Remove less water if not sure as it is less tressful then tking too much in general . Obviously there are some people that need a lot taken off , but if you are otherwise ok then less is better. Its safer to be less agressive . Overtime you begin to se how this works. Sometimes we try to do too much and beat up patients.

[Rerun]

How much of one's pee is water?