Feeling washed out after dialysis

[rnbob]

I am a Dialysis Nurse and see this all too frequently with my patients, I also guess that most of the problems are due to a dry weight set too low-What do you guys think? I came here because I thi8nk there is a wealth of knowlege here that I would like to tap into. Please help me to help my patients.

[greg10]

I am a Dialysis Nurse and see this all too frequently with my patients, I also guess that most of the problems are due to a dry weight set too low-What do you guys think? I came here because I thi8nk there is a wealth of knowlege here that I would like to tap into. Please help me to help my patients.

Welcome to the forum.   
Wrong dry weight is possible.  Another possibility is that many clinics don't seem to practice the ultrafiltration limit rule of 10ml/kg/hr.  That is, if you weight 50 kg, your limit on UF should be no higher than 50kg x 10ml/kg/hr = 500 ml/hr.  Many times you see a one size fits all UF profile for in-clinic dialysis. 

*The following is my own newbie rule for UF limit taking age into consideration.
There should also be a formula that takes age into consideration for UF rate limitation, for example it could be a multiplier of (130-age)*100, such that if you are 70 years old, you would put in (130-70)/100= 0.6; multiply that by 10ml/kg/hr = 6ml/kg/hr.  If the 70yr old patient is 50kg, then the UF should probably be about 50kg * 6ml/kg/hr = 300ml/hr.  Similarly, an 80 year old patient weighing 50 kg should probably have a UF rate limit of 250 ml/hr.

The general formula could be:

  UF limit = (weight in kg)  *  10 ml/kg/hr * (130 - age)/100

Yes, the formula suggests if you lived to be 130 and had to be dialyzed, your UF limit should be 0. 

[rnbob]

Thanks soo much, I'll be sure to try this before adjusting a dry weight

[PatDowns]

@greg10

I will assume you came up with the "Rule of 10" from this Abstract in the KI Journal -

http://www.nature.com/ki/journal/v79/n2/abs/ki2010383a.html

However, where did you find the age factor in literature?

[kamar55]

As someone who's been on D for 6 years, I still experience that washed out feeling. I find that the more kilos they have to pull, the lousier I feel. So that's one of the incentives to keeping fluids under control.

[Gandalf]

It seems to vary from day to day, and for sure, how I feel at starting does influence how I feel at the end.  The factors which really make me feel very bad are my low BP, which tends to drop quite alarmingly - the more the fluctuation, the worse I will feel; the fluid removed (the more I remove, the harder it becomes, obviously!), and even other random factors such as mental state and nutritional status at the time, HB at the time and K at the time.  It is definitely not only a function of the wet/dry weight equation, although that is clearly a major thing.

[KICKSTART]

I dont think there is anyone who does cartwheels after dialysis , mostly due to the fact it is not natural to have your blood pulled out of your body , sent round a machine and then pumped back in. Is it any wonder we are washed out ?

[Hazmat35]

I have been on Dialysis for 9 months now. . . and that washed out feeling has not gone away yet.  After about 1 hour after treatment, I am so exhausted that all I can do is go to bed.  Luckily, mine is done in late afternoon, and I get home from my treatment about 6:00 PM. 

[greg10]

@greg10

I will assume you came up with the "Rule of 10" from this Abstract in the KI Journal -

http://www.nature.com/ki/journal/v79/n2/abs/ki2010383a.html

However, where did you find the age factor in literature?

I made it up.  I did prefaced it by writing that it is my newbie rule 
But it is something we follow in our dialysis and in practical terms that means slower blood flow and longer treatment time, but allowing for a smaller UF rate of about 300 ml/hr (or less) in our case.  With NxStage home hemodialysis, we don't find this limitation in smaller UF rate to be a problem because with 5 times of treatment per week at about 4 hours per treatment, there is plenty of time to remove fluid from a patient and we are not pressured into removing excess fluid rapidly due to time constraints.

Please note that the patient has to have responsibility as well to maintain their fluid gain by limit their fluid intake, which is generally limited to 1 liter per day, but again that number is also patient dependent as some ESRD patient can still urinate and could produce perhaps a few hundred ml per day.

[The Lone IT from HM]

I would like to give you a sneak peak of an article that is coming out shortly, but I would get hung by my really sensitive parts.  I will post it when it is published.  In the summary, it has 5 possible outcomes of each treatment and what should happen during the next treatment.  one of the things that is considered for each outcome is "Sx of Hypovolemia/postdialysis Fatigue".  It is part of a simple test at the end of each treatment, and it could improve your life on dialysis.

[Riki]

I've been on HD for about 2 years now.  I'm tired when the treatment is done, but I'm not one of those people who goes home and goes to bed.  Most night, I do just go home and spend the evening watching tv, but there are times when I'll go out after dialysis and go to supper with my girlfriends, or go to a movie or a play.  Last year, when my cousin got married, my mom picked me up, and we stopped at home long enough for me to drop off my dialysis stuff, and pack a few things, and we caught the last ferry to the mainland to be there for her wedding the next day. 

If I want to do something after dialysis, I can, but most of the time I just want to go home and watch tv.

[tyefly]

Sounds like what I use to experience when I was in center..... now that I do home dialysis   I   NEVER   crash  or feel tired after  the 4.29 hrs that I do 6 days a week......   Seriously.....   I feel way better and after I am off ... I never sit down again for the rest of the day....  I do everything I have always done before CKD....   I got to say  that  this has only happened since I went home... no more cramps, low BP,  lack of energy.....
  I just wish more people could recieve more dialysis so they would feel like tackling the world Like I do....  I now feel more like my old self..... 

[Riki]

I can't do home hemo, because I need someone with me who is willing to needle me.  My mom is the only person with me, and she refuses to do it.  I have poor eyesight, so I can't do it myself.  I'm ok with the dialysis I get now, as it doesn't slow me down unless I want to slow down.