How do you cope with fluids?

[julian230]

So your on Nxstage and (i've posted something earlier about this) how do you cope with your fluid restrictions ? are they're any? if so , how much is your allowances per day? i might be starting

[Rerun]

I'm not on NxStage, but coping with any fluid restriction starts with restricting (NONE) salt.  You will get some salt in foods and I eat Frito Scoops, but then I'm thirsty.  Just watch your salt.

[julian230]

I'm not on NxStage, but coping with any fluid restriction starts with restricting (NONE) salt.  You will get some salt in foods and I eat Frito Scoops, but then I'm thirsty.  Just watch your salt.

less salt , more fluids?

[Rerun]

Salt makes you thirsty.  The more salt you eat the more it makes you thirsty.  So the less salt you eat the less your body wants to drink.  Salt also retains fluid.  If you still pee at all it is a problem.  I don't pee at all, so if I eat something salty then I get thirsty and also gain fluid weight.  It is hard during dialysis for me to take off LOTS of extra fluid.  I will also cramp if I eat too much salt. 


I paid for last weekend!  AHHHHH  I still remember!  (That is a good thing for me)

[G-Ma]

I'm on nxstage with no fluid restrictions...I usually only have .5 to remove per day.......in center I was on restrictions..32 oz per day and I generally had a tough time because I was always thirsty...nxstage is lactaid based and I'm not thirsty and the dietician told me the other day to use more salt..how funny.

[julian230]

I'm on nxstage with no fluid restrictions...I usually only have .5 to remove per day.......in center I was on restrictions..32 oz per day and I generally had a tough time because I was always thirsty...nxstage is lactaid based and I'm not thirsty and the dietician told me the other day to use more salt..how funny.

so technically , if you wanted to you could have more than 32 oz , like maybe the normal 64 ounces per day? tell me that ain't so... 

[G-Ma]

I have been told no restrictions but I'm just not thirsty and have trouble forcing myself to even get the 32 oz.

[Rerun]

It depends on if you are still producing urine.  If you are still producing urine you get to drink more than the preson who does not.  What goes in must come out.....or get dialysis.

[G-Ma]

nope don't pee

[Run8]

Hey Julian, I'm use the nexstage and let me tell you. At first it was kinda hard because a person,or i should say a person on dialysis, gets use to that restriction. So at first the Nurse at the clinic would have to tell me everyday that i need to drink more. They told me I was fine with taking 2 kilos off per day. My Neph. said try not to go over 2.5 kilos per day. You can drink this much and take this much off because you are doing it daily.

[julian230]

Hey Julian, I'm use the nexstage and let me tell you. At first it was kinda hard because a person,or i should say a person on dialysis, gets use to that restriction. So at first the Nurse at the clinic would have to tell me everyday that i need to drink more. They told me I was fine with taking 2 kilos off per day. My Neph. said try not to go over 2.5 kilos per day. You can drink this much and take this much off because you are doing it daily.

so how much would that equal? without too much complications ..., how many ounces of water/fluid would i be able to drink with nxstage?

[Bill Peckham]

Hey Julian, I'm use the nexstage and let me tell you. At first it was kinda hard because a person,or i should say a person on dialysis, gets use to that restriction. So at first the Nurse at the clinic would have to tell me everyday that i need to drink more. They told me I was fine with taking 2 kilos off per day. My Neph. said try not to go over 2.5 kilos per day. You can drink this much and take this much off because you are doing it daily.

so how much would that equal? without too much complications ..., how many ounces of water/fluid would i be able to drink with nxstage?

One Kilo is equal to one liter. A liter is just a bit less than 34 ounces.

The amount of fluid you can comfortably remove per hour depends on a couple things - how big you are (the more you weigh - your dry weight - the more you could comfortably remove an hour) and salt plays a role in how much fluid you can comfortably remove. Rerun is exactly right that controlling salt makes controlling your thirst much easier but salt also limits how much fluid you can comfortably pull off each hour.

In general people find they can (aside from the first hour) pull off between .3 and .7 liters of fluid an hour - between 10 and 25 ounces if you like. From there it depends on how often and how long you are dialyzing. I dalyze while I sleep; I dialyze between 48 and 56 hours a week. And I am comfortable pulling off up to .4 liters an hour. I have no real restrictions - I don't limit myself.

[jbeany]

I'm on NxStage with regular daily treatments.  I have a hard time pulling off more than 3 in a run, so I limit my fluids to 2 L when I have dialysis the next day, and 1.5 on the days I have off.  It depends on what you are comfortable with, and what your body can handle.  In general though, you can drink more with the NxStage because you have more frequent treatments, so you don't have to worry about it building up over the days off.  I can drink a lot more now that I could with in-center.

[Bill Peckham]

There are some good papers out there on fluid removal; this is how I understand it.

The body is mostly water - call it 60%. To make the math easier lets use a 100 Kilo person as an example. The reason to use the metric system is because kilos and liters are the same - one liter of water, weighs one kilo. So for the 100 KG example - the guy contains 60 Liters of fluid at his dry weight. His dry weight is what he would weigh if his kidneys worked. So if he comes into dialysis weighing 105KG we would say he is 5KG over dry; he needs to have 5 liters of fluid removed.

Well what is the problem - why not suck off the 5 liters in a couple hours and send him home? Why would he likely feel much better if he removed the fluid over eight hours instead of four? Or why would he feel so much better taking off 2.5 liters two days in a row rather than 5 liters all at once?

The fluid in the body is actually in three compartments. There is fluid in the blood system - obviously. There is fluid in the space between the cells. And there is fluid in the cells. Each compartment is separated from the other compartments by a membrane. The walls of the capillaries separate the blood from the space in between the cells. And the space between the cells and the space inside the cells are separated by the cell wall. The capillary walls and the cell walls act like the membrane in the artificial kidney - fluid (and waste) can pass through the membrane.

When our 100KG guy comes into dialysis the fluid is evenly distributed throughout the body. Each fluid compartment - the blood, the space between the cells, the space inside the cells - contains its portion of the extra 5 liters. Dialysis has to remove the fluid from all three compartments but it only has access to the blood. When we dialyze the dialysate that carries away extra fluid can only get fluid out of the blood. The rest of the fluid has to migrate to the blood from the other fluid compartments in order to be removed. This is what takes time.

The speed that fluid can go from one compartment to the other is between .3 liters/hour and .7 liters/hour. When you hear me and others saying that sodium makes it harder to draw off fluid this is what we're referring to - the rate that fluid will transfer between the fluid compartments of the body.

The big complication is that the fluid compartments are different sizes. For every liter of fluid in the blood stream there are two liters in the space between the cells and four liters in the space inside the cells! This means our 100 KG guy has about 8 liters of fluid in his blood stream, 16 liters of fluid in the space between his cells and 32 liters inside his cells (the missing 4 liters is in solid organs e.g. the liver, spleen and is rounding).

Think about this we need to take off 5 liters but in total there is only 8 liters in the blood. I believe people cramp when the blood compartment gets to about 85 - 90% of capacity. If he can comfortably remove fluid at .7 liters an hour (controls his salt and has favorable genetics) ... over 7.5 hours he may have a comfortable treatment. As fluid is being removed from the blood space, fluid will flow from the space between the cells into the blood replacing the drawn off fluid (then fluid will flow from the cells into the space between the cells at about the same rate).

Change how fast fluid is coming off (change the ultra filtration rate) because time is shortened and you can see he might run into problems because the fluid volume of the blood compartment will fall below some critical point - 85% or so. Change how fast fluid transfers from one compartment to another (because of poor salt habits or unfavorable genetics) and again he might run into problems because the fluid volume of the blood compartment will fall below his cramp percentage.

Now if you've followed me so far consider if the person's dry weight is in the 50 KG range and they come in 5KG over dry. Imagine they've had trouble limiting their sodium. They are going to be in a world of hurt and they will not be able to get dry. The physics of the situation requires more time on the machine to have any chance of getting dry. Using NxStage gives you more time on the machine which is the great advantage of dialyzing more frequently.

[julian230]

Thank you all for letting me be informed about the NXstage and fluid. From my understanding, you can drink more water/fluid for that matter. Not much like 88 ounces a day, but certainly more. Than again , it depends on how I cope, so it would be difficult to say how much I could drink a day. For all we know , I might start  cramping when taking off .3. I'm a small guy, and weigh about 46.5 kilos. (though it's been the weekend , so I'll say I weigh 49.6)   Regardless, thank you for responding and giving me a better understanding. Bill Peckman, I use to go to your site all the time to read the different articles, corny as it may be, it was an honor to have your input. Thank you!

[G-Ma]

Thank you Bill..that was interesting.
Ann

[Wallyz]

I am a large (118kilo dry) guy and I have some residual kidney function (150 ml/ day)

I don't really have any fluid problems, especially when I exercise and sauna.  I can remove 1.5 kilos/ water in a 45min workout and sauna.  This was not the case when I was on in center dialysis.

Go NxSatge and you can have that tall glass of Ice water you have been dreaming abotu.

[flip]

I don't watch my fluid intake as much as I should but pulling off 2-3 kilos in a session doesn't really bother me.

[paris]

Julian,  We all think Bill Peckham is a rock star!   Good to see so many answers for you.   

[flip]

maybe we can soon do audio files on here.....then we'll see who the real rock star is