Feeling Like Crap after Treatment? Maybe this artcle will help.

[The Lone IT from HM]

I have read in the post here more time than can be counted how bad or run down individuals feel After Treatments.  I have also been told horror stories by our Hema Metrics Trainers (Long time Dialysis Nurses, each and every one of them).
I am going to post only the Summary of an article that will give you some understanding why you feel bad at the end of a treatment, and let you know how to correct the problem.  the Whole article is going to be posted at www.hemametrics.com, if you want the details.

Author: Anne Diroll

Summary
Weir articulates it best in his editorial commentary in Hypertension: “Ultimately, the main goal of treatment of blood pressure is to prevent cardiac events. Perhaps the most important strategy in the dialysis patient is to achieve an appropriate dry weight, minimize volume overload, and use blood pressure–lowering medications only in the setting of ‘hypertension’ when dry weight is truly probed and demonstrated. It is possible that if more patients achieved dry weight, then less antihypertensive medication would be required, as is observed in patients on longer-session nocturnal hemodialysis. I suspect that long-term volume/pressure overload of the left ventricle, because of inadequate achievement of dry weight, may be one of the most important cardiovascular concerns in the hemodialysis patient.”10
I do believe euvolemia is possible. In the Grass Valley study (Rodriguez et al), we evaluated post-dialytic vascular compartment refill. After deciding that refill could be evaluated after 10 minutes of ultrafiltration in minimum (200mL/hour), we used the following steps.
Step 1. Note hematocrit
Step 2. Place UF in minimum
Step 3. Wait 10 minutes
Step 4. Note hematocrit

If hematocrit declines by 0.5 or more in 10 minutes, patient has refill, and is “not dry.” If hematocrit declines by 0.4 or less in 10 minutes, patient is "vascularly dry." If additional fluid is available, and willing to shift from the extracellular compartment to the intravascular compartment, it will decrease the hematocrit by hemodilution, hence the "not dry" patient has a decline in hematocrit in the absence of ultrafiltration.
Blood                   Postdialytic           Sx of hypovolemia/                     Dry weight
Volume                  vascular              postdialysis fatigue                         change
Reduction                 refill
Yes                           No                              No                                     No
Yes                           No                             Yes                              Revise up
Yes                           Yes                            No                               Revise down
Yes                           Yes                            Yes                              Revise down
No                             No                             No                               Revise down

Mathematically, blood volume is a function of both ultrafiltration and plasma refilling. As Boyle & Sobotka noted, the hypothesis of titrating decongestion therapy to reduce interstitial edema without embarrassing intravascular volume is applicable to all forms of decongestion therapy. Using hemoconcentration as a surrogate for PRR is amenable to therapies in which there is continuous access to blood such as ultrafiltration.