CAPD people. I can't get my weight down.

[Hanify]

I've been doing CAPD for a year, so I feel like I should know better, but I sometimes have a kind of bad runwhere I can't get down to my goal weight.  I'm using 2.5 bags at night, and at the moment doing two 2.5 manual bags during the day.  My albumin is low, and apparently this affects how well the fluid comes off, and I'm trying not to drink much - I hate that though.  So, other than increasing my albumin (which I am trying to do) does anyone have any ideas?  Do I just wait through this phase, and not worry about it?  I feel OK, but am constantly worried about becoming overloaded.







EDITED:Moved to home dialysis section-kitkatz,Moderator

[KICKSTART]

I did CAPD for 5 yrs and have just changed to APD . Firstly what strength bags are you using ? The stronger the bag the more fluid it pulls off , secondly i notice you are only doing 2 exchanges during the day ? !!! I always did a minimum of 4 ! My regime was 2 green,1 orange and 1 extraneal at night. I think firstly you should talk to someone about why you are on so few exchanges during the day because the after a certain period of time if you dont do an exchange your body starts to absorb the fluid , which wont help with keeping your weight down!! It might be worth thinking about APD unless there is a reason you cant do it , it does give really good results .. and all while you sleep!!!

[Hanify]

No - sorry my fault.  Should I have said I'm on APD?  I have the cycler at night.  See, I don't even know the terminology of what I'm doing ha ha.  So I should only be doing one bag during the day.  I'm using 2.5% all the time at the mo.  This used to always bring my fluid down, but it's not at the moment.

[TiffanyJean]

I still don't fully understand this whole PD process, Richie has explained it to me a million times and this is the one bit of kidney information that doesn't fully fit in my brain at the moment.... but here is my  for as much as I can understand, and what I've seen Richie do. (BTW I'm not a math person... )

This is what Richie does with his cycler: he has 5 exchanges over 9 hours at night, has high calcium bags, and uses 3 green bags on most days; and when sometimes uses 1 red bag with 2 greens. He then has 1 day exchange when he uses a green bag.

Not sure if that helps... but if your retaining fluid then you might try adding a red bag at night.

tiffany jean

[KICKSTART]

Right ..doh!  So how many bags do you use at night ? How long are you on the cycler for?  When you say you use 2.5 bags i presume you mean 2,500ml ? What colour bags do you use ?  My regime is normally 3 green, 1 orange and my last fill is extraneal which i leave in all day. If i find im not pulling enough fluid off i swap one of my greens for an orange , so 2 green , 2 orange and that usually works. Unless you have been drinking more than usual it sounds like your regime might want changing?

[Hanify]

I do 2 6l green bags at night.  It's a 9 hour process.  I just don't get why everything will suddenly change when you've been going along nicely for ages.  Ah well, I'll just wait and see I guess.

[KICKSTART]

Sorry dont mean to be rude ...but are you sure ? 2 6 litre bags a night ? Ive been doing dialysis for 6 yrs now and have never even heard of 6 litre bags ! (its possible its an American thing? ) Im sorry i can only go off what i know but it doesnt seem right that you are only doing 2 exchanges per night ? I told you i do 5 exchanges per night and mine lasts around 8 hrs , to me something seems wrong with your regime ..no doubt other APD users will have an opinion , maybe you do things different over there ? but to me its no wonder you are not pulling any fluid off if you are only doing 2 exchanges .. ps ..just looked again , they cant be 6 litre bags ..you would explode !!!!

[Savemeimdtba]

I think he means he uses 2 bags with 5,000 ML's in each (6 liter's)... he doesn't put all that in at once - so maybe he does 4 or 5 exchanges.  I use 3 of the 5,000 ML bags for 5 exchanges over 9 hours. 

I have no advice on how to pull off more fluid other than upping the strength of the bags... but 4.5's are generally bad for you.  So maybe if you just used one, got some of that weight off and then went back to your 2.5's things might even out?  I don't know - can you call your nurse and ask her?

[KICKSTART]

Ah right ..we dont have bags that size! Iirc our biggest is 2500. If thats the case its down to how many exchanges you do in one night .. that could need changing. You could do what i do to pull extra off and that is to use an orange bag a when you feel overloaded . I swap and change depending on how i feel at the end of the day. Also ..what do you do during the day? Any manual exchanges or empty? I have extraneal in all day, while it doesnt pull off toxins it does pull off fluid.

[jdy123]

I've never heard of an orange bag.  What strength is it?  I've only used yellow, green and red.

[KICKSTART]

Green is 2.27 ...Orange is 3.36   I havent seen 'red' ones .. what strength are they ? Do you mean extraneal?

[Savemeimdtba]

Ah, we don't have an orange over here... we have:

Yellow - 1.5
green - 2.5
red - 4.25

I only use yellow at the moment and green's occasionally... I've never used a red and I don't want to!  I hear they are bad for your stomach. 

[jdy123]

What kind of problems will I get for using reds?  I use reds all the time.  I was using 3 reds + 1 greens for a couple of days.  Normally, I use 2 reds + 2 greens or 1 red + 3 greens.

[Hanify]

Sorry I was a bit unclear.  As you've gathered the two bags ar 6000ml each, but the machine does 5 cycles with those bags.  Our colours are yellow = 1.25 green = 2.25 and orange = 4.25.  I do one green during the day.  My issue is that doing all greens used to be fine and would always take off more than I needed to, so then I woul use the occasional yellow when I didn't need to go down any further.  I've just found lately I can't get down to my goal at all.  Mind you, I feel fine, so maybe I've just put on some body weight (which is a good thing for me).  Thanks for all your thoughts by the way.  It's so nice to talk to people who know how I feel.

[KICKSTART]

Yeah i used to be the same ..started on yellows , then they didnt pull enough off , so moved onto greens , same again  so now its a combination of green and orange. I think its just the way it goes !

jdy123...As far as i know the stronger the bags , the more it wears your peritoneum out! Thats why they like us to use the weakest bags possible.

[peleroja]

Have you considered that it may not be fluid you are retaining, but actual body weight?  Over the 5 years I gained 50 pounds, as the amount of dextrose I was using (mostly 2.5) increased my calorie count by 800 to 1,000 calories a day.  All that without even eating.  Once I started riding my stationary bike 10 minutes at a time, 8 times a day, I began to lose weight.  Perhaps a little more exercise to compensate for the extra calories. Just a thought.

[george40]

Your goal / dry weight will change. Over the past 5 months I have gained weight. Finally the nurse told me each bag is probably somewhere around 300 calories. Eeeeek! So it could be weight gain. Now I try to stick with 2.5% bags instead of the 4.25%. But if you can determine it is fluid, you might want to try mixing in a 4.25% with a 2.5% bag. If its not fluid you could become dehydrated by pulling off too much.

Ways I know Im building up fluid: 1) Blood pressure is higher 2) Swollen feet + ankles.

I hope this helps.

[Hanify]

Thanks for all your thoughts.  I think it may be body weight.  I lost 20kgs when I got sick, so now I'm kind of unsure about what weight i should be!  I'm a shadow of my former self ha ha.I feel like I get settled into a good regular pattern which lasts for a month or two, then bang, it all goes haywire.  Probably just one of the many joys of dialysis!

[KICKSTART]

Dont rely on that old 'body weight' one as a lot of people like to convince themselves it is ! Get re- assessed and get a new target weight is the best thing to do . Its never an exact science ! My weight varies up to 4 kilos and as soon as i reach my target weight , they set me another. I also asked , how do you not know its actual weight ?as im eating well at the moment and they told me there are several different ways of telling actual weight as compared to fluid overload. If you are yo yo ing alot , get the doctor to have a look at you .If its only a few kilos you're going up and down , then thats pretty normal ! Also as i said to someone else ..dont rely on your legs for fluid overload , it can build up unseen all over your body !

[jdy123]

Finally the nurse told me each bag is probably somewhere around 300 calories. 

'300 calories" per bag!!!  I use four bags (3000 ml each).  That means 1200 calories extra for each dialysis?  No wonder I am gaining weight even though I'm not eating much.  (Or again, its probably water weight).