Ever Wonder About the Calories?

[peleroja]

I received the following info from my renal dietician re calories absorbed from dialysate.

Manual
1.5% (yellow) 23 calories per litre
2.5% (green) 39 calories per litre
4.25% (red) 66 calories per litre

Cycler
1.5% (yellow) 33.5 calories per litre
2.5% (green) 56 calories per litre
4.25% (red) 95 calories per litre

I've now figured out why it's getting more and more difficult for me to lose weight in spite of doing 90-120 minutes a day on my exercise bicycle.

On manual, an all green day for me using 2000 bags equaled 468 calories.
When I first went on the cycler an all green day using 2500 bags equaled 840 calories
My prescription increased in May of this year, so an all green day on the cycler is now 937.5!!!!!

Without that bicycle I would be a little porker!

[Restorer]

Is that specific to you, or did your dietician also include assumed dwell times? Dextrose absorption depends on how long you dwell with the dialysate, and your PET test can tell you what that curve is.

(All info AFAIK and IIRC)

[KICKSTART]

No wonder i have piled on the weight when you x that by all the years ive been on PD , its a wonder im not like Paverotti    (shame ive been trying to convince myself it fluid since i started on hemo ! )

[looneytunes]

I had been wondering about this very topic today.   Hubby has steadily been gaining weight on PD, particularily after his RX was increased to 11,500 ml per day.  He uses 6000 green and 5500 yellow daily.  He had been gaining and I was concerned that it was fluid buildup because he was not eating enough to cause him to gain 10 lbs in a month. 

Thanks again for the info!

[girliekick]

525 daily for me, i was told id loose weight if i were able to cut 500 cal a day.  mind you these are carbohydrate calories....... The equivalent of downing 5 sodas extra every day.  ugh ihatedialysis!!!

[peleroja]

Rrestorer, the chart lists how many actual calories per litre: yellow 51, green 85, red 145.  It then lists both the approximate from-to of each litre that a person is likely to absorb, and then an average that a person is most likely to absorb per litre.  I gave everyone the average.  If you'd like a copy of the entire chart, I would need your actual email to send it as an attachment.   Don't think I can do attachments with IM.

[Savemeimdtba]

Well THIS makes me feel better and angry at the same time I've gained SOOO much weight since starting the cycler.. I don't even know what to do.  I'm considering learning to be anorexic but I like food and I don't wanna lose the ability to do PD So what do we do?? 

[peleroja]

Well THIS makes me feel better and angry at the same time I've gained SOOO much weight since starting the cycler.. I don't even know what to do.  I'm considering learning to be anorexic but I like food and I don't wanna lose the ability to do PD So what do we do??

I'll tell you what I did.  I started riding my exercise bike 10 minutes at a time, 6-8 times a day.  If you haven't exercised in a while, start more slowly, maybe 5 minutes at a time.  Believe it or not, it does begin to add up.  I lost 60 pounds that way.

[sico]

I haven't gained weight actually since starting PD, but maybe lost muscle and gained fat.
My appetite isn't there anymore, so calories from the dialysis fluid is probably a good thing for me.

[koutsounel]

My appetite isn't there anymore, so calories from the dialysis fluid is probably a good thing for me.

this is excactly what we have been told, and dieticians take it into account when they prescribe the feeds

[Maker]

This is exactly why I haven't really considered PD, in spite of the great results it sounds like people get from it compared with HD.  Isn't there a different type of solution that does not have the calories? 

Combine weight gain with carrying fluid around in your stomach...I just don't think its for me, even though 3 1/2 hours 3 days a week in-center really isn't either 

[peleroja]

Isn't there a different type of solution that does not have the calories? 

Yes, it's called Extraneal and is starch based rather than dextrose based.  They usually put diabetics on it.  I tried it, just to reduce calories, and man, oh, man, did it give me the nastiest HOT rash!!!!!

[Jie]

Like Restorer said, dextrose absorption depends on dwell time and transport rate, and varies greatly from person to person. A mean value may not mean a lot to an individual person. I have not had any weight gain problem during the last 7 months. What I need to do is just 3 to 5 miles of walk each day. I am working full time. If without working, I would have much easier time to do the walking. If a patient cannot walk, it is a different issue. 

[sico]

Like Restorer said, dextrose absorption depends on dwell time and transport rate, and varies greatly from person to person.

So what do you reckon I'd only absorb calories on my day dwell when I start to reabsorb dialysis fluid?
Whereas at night on the cycler the dialysis solution is still pulling fluid from me when it's drained?
Does my question make sense?

[Jie]

Hi Sico,

It does not work this way. The way we absorb calories is whenever we have solution in our belly. Our body takes in the sugar just like the fluid takes out other things from our body. The flow is two ways, eventually making the solution similar to other fluids in our body.  The sugar content in the solution starts to decline after filling.  The longer dwell time, the higher absorbsion of sugar. The higher transport rate, the higher absorbsion of sugar. 

[*kana*]

I guess we just can't win, can we.   
 
PD=extra calories and weight gain. 
Transplant=lots of weight gain from steroids, cancer and diabetes risk.
Hemo=feeling like crap every other day.  Less fluid intake, less potasssium.   

[jennyc]

If you can use extraneal it is really good for weight management.... so far the first time i did dialysis i used all 1.5% doing manual exchanges (when i started to regain some function i started weeing again) i put on just over 25 kilos. this time around using extraneal and the cycler doing more exchanges than the first time (10000 mililitres instead of 8000 mililitres) not only haven't i gained any weight i've actually lost almost all of it (being sick doesn't help). Almost back to my pre-pregnancy days (only 5 dryweight kilos to go ).

sorry edited to correct litres to mili-litres

[sico]

If you can use extraneal it is really good for weight management.... so far the first time i did dialysis i used all 1.5% doing manual exchanges (when i started to regain some function i started weeing again) i put on just over 25 kilos. this time around using extraneal and the cycler doing more exchanges than the first time (10000 mililitres instead of 8000 mililitres) not only haven't i gained any weight i've actually lost almost all of it (being sick doesn't help). Almost back to my pre-pregnancy days (only 5 dryweight kilos to go ).

sorry edited to correct litres to mili-litres

25kg! Thats a huge weight gain. I just use a 2.5 and a 1.5 about 4 nights a week and the other 3 would be 2x 2.5.
Really only gained about 1kg in 9months. Doing 4 x 2200ml a night (8800ml) with 1000ml final fill.
My initial drain is usually around 1000ml also. How big is your final fill and what is your initial drain usually?
Got to be pretty happy to have lost that weight.

[jennyc]

25kg! Thats a huge weight gain. I just use a 2.5 and a 1.5 about 4 nights a week and the other 3 would be 2x 2.5.
Really only gained about 1kg in 9months. Doing 4 x 2200ml a night (8800ml) with 1000ml final fill.
My initial drain is usually around 1000ml also. How big is your final fill and what is your initial drain usually?
Got to be pretty happy to have lost that weight.
[/quote]

The first time I was on in the last few months my kidneys kicked back in from no where, i went from 0 function when i left hospital to almost 23% when i came off. so near the end i was absorbing almost all the 2lt in 5 hours. I think that's why i gained so much wieght. I left hospital at 60kg and was nearly 85kg when i came off PD. It was Yucky! before i fell pregnant i'd never been more than 58kg. That photo is recent, and the only one i have where i don't have a tripple chin....

When PD was working i filled with 1.2lt of icodextrin (extraneal) in the daytime even then i would pull of 1800ml for the idrain- i was a really fast transporter. at that time i was also only doing 7200ml a day in total. I was at work one day when i was using 2lt of extraneal and i had to leave, the pressure of all the fluid was pushing on my diaphram- couldn't breathe. i think i pulled off nearly 2800ml. it works so well at pulling fluid off that i couldn't cope with anymore than 1.2. Now I day fill with 1.7 lt of extraneal. my initial drain now is only 1900- so yeh pd is definately not working well. I'm just lucky that i'm still passing a lot of fluid. that's the main reason i hesitated so long with changing to heamo. i remember what the fluid restriction is like and can stand it. At the moment i have no restriction. During the cycle i fill with 2000ml of 1.5% so my total fill volume is actually 9700ml. my uf is about 450ml.

Which hospital do you run out of? check if they'll let you do extraneal- if it's compatible for you. I'm not sure if anyone else had the same problem with it ripping lots of fluid off (not that that would be a problem for most) and it is a long dwell bag so it's performs optimum after i think the nurse said 6 hours and it doesn't get reabsorbed into the system. I've found that if i've pulled off less than i put in i have a blockage. I've never had extraneal reabsorb.

[sico]

The first time I was on in the last few months my kidneys kicked back in from no where, i went from 0 function when i left hospital to almost 23% when i came off. so near the end i was absorbing almost all the 2lt in 5 hours. I think that's why i gained so much wieght. I left hospital at 60kg and was nearly 85kg when i came off PD. It was Yucky! before i fell pregnant i'd never been more than 58kg. That photo is recent, and the only one i have where i don't have a tripple chin....

When PD was working i filled with 1.2lt of icodextrin (extraneal) in the daytime even then i would pull of 1800ml for the idrain- i was a really fast transporter. at that time i was also only doing 7200ml a day in total. I was at work one day when i was using 2lt of extraneal and i had to leave, the pressure of all the fluid was pushing on my diaphram- couldn't breathe. i think i pulled off nearly 2800ml. it works so well at pulling fluid off that i couldn't cope with anymore than 1.2. Now I day fill with 1.7 lt of extraneal. my initial drain now is only 1900- so yeh pd is definately not working well. I'm just lucky that i'm still passing a lot of fluid. that's the main reason i hesitated so long with changing to heamo. i remember what the fluid restriction is like and can stand it. At the moment i have no restriction. During the cycle i fill with 2000ml of 1.5% so my total fill volume is actually 9700ml. my uf is about 450ml.

Which hospital do you run out of? check if they'll let you do extraneal- if it's compatible for you. I'm not sure if anyone else had the same problem with it ripping lots of fluid off (not that that would be a problem for most) and it is a long dwell bag so it's performs optimum after i think the nurse said 6 hours and it doesn't get reabsorbed into the system. I've found that if i've pulled off less than i put in i have a blockage. I've never had extraneal reabsorb.

Thats what they hoped would happen to my kidneys when i was first hospitalized, once my bp was under control that my GFR might improve. No such luck. I could not imagine what that'd feel like (gaining the weight), I've never been over 68kg. Nobody wants a tripple chin, after looking at your pic it's hard to believe. I know the feeling when you can't breathe due to pressure on the diaphram, I drained 3600ml in a cycle once.
To keep my weight stable I have to UF around 1000ml per night, still pass about 700ml a day. I try to drink between 1500ml to 2000ml.
My PD unit is St Vincents in Melbourne. Will avoid the stronger solutions for as long as possible jen as they wear out your peritoneal membrane
quicker.

[jennyc]

i meant to say "i remember what the fluid restriction is like and can't stand it." stupid laptop skips the T and V sometimes.

Yeh, that's where i'm at now! I had no idea that sped it up but for me i still probably would have done it (gone to extraneal) to keep the weight down. So for me it would have been a loose/loose situation. Still I had a few good years on PD. Can't complain, I'll just take lasix for as long as possible when i start hemo, i did that the first time when i had not function and it worked.

My weight is pretty stable now, am down to 63/62 dry weight it's dropping a bit slower now than a month ago. I lost 6kg in about 5 weeks- i'm sort of forcing myself to eat now, at least enough so that I don't drop too much wieght cause i know it'll just come back once i'm healthier again.

Wow, 3600ml is huge, was that off 2000ml? You must have had some fluid trapped between your intestines. My largest recent drain was after i got out of hospital after the revision of my fistula, i think it was 2800ml of 2000ml. But i know i was holding onto some fluid. Are you on Baxter or Fresineus?

[sico]

i meant to say "i remember what the fluid restriction is like and can't stand it." stupid laptop skips the T and V sometimes.

Yeh, that's where i'm at now! I had no idea that sped it up but for me i still probably would have done it (gone to extraneal) to keep the weight down. So for me it would have been a loose/loose situation. Still I had a few good years on PD. Can't complain, I'll just take lasix for as long as possible when i start hemo, i did that the first time when i had not function and it worked.

My weight is pretty stable now, am down to 63/62 dry weight it's dropping a bit slower now than a month ago. I lost 6kg in about 5 weeks- i'm sort of forcing myself to eat now, at least enough so that I don't drop too much wieght cause i know it'll just come back once i'm healthier again.

Wow, 3600ml is huge, was that off 2000ml? You must have had some fluid trapped between your intestines. My largest recent drain was after i got out of hospital after the revision of my fistula, i think it was 2800ml of 2000ml. But i know i was holding onto some fluid. Are you on Baxter or Fresineus?

I do struggle sometimes, with the fluid restrictions. Every few months i have a night off 'D'. Last time I gained 3kg in one night, few beers at the pub didn't help. I don't drink much alcohol as find that dehydrates me then have to drink more water.
Does sound like you had good years on PD, did well to avoid peritonitis. Hopefully HD doesn't knock you around too much. I used to feel weird after a HD run, like it was sucking the life out of me at times.
I've had to force myself to eat too, so hard with the PD fluid in there sometimes. I think i was too strict with the diet restrictions in the beginning.
I'm on the Baxter cycler jen. In one cycle (the 4th of the night) it said I UF'd 1533ml off of 2200ml so 3733ml drained . Obviously the previous dwells would've all been negative UF. I slept right through it too. Its all going so smoothly for me now, rarely get alarms. My first catheter did not work well, endless alarms.   

[jennyc]

Hey Brad,
I've had the ocassional night off as well, usually i'd do an extra bag in the arvo and then we'd head to star city. I'd try to catch up the next day though (at least only be down 1 bag or so).
I use Baxter as well, it's pretty easy. I'm not too impressed with my catheter. It has always caused a lot of pain. I can't be empty, i double over. I stay awake for the first drain then i'm usually ok. The first drain kills though. When I had it put in it was a new surgeon  I hadn't delt with before, i begged him to not put it so far in, you know drop it in and then just pull it up a faction of a millimetre. I think he jammed it in deliberately. But i had the same pain with the first catheter. I wonder if the peritoneum ever regains its ability to dialyse?

I hated in-hospital HD. Since i'm already a home patient and i like my independance i'll be doing home HD. We run our own business so i can't afford to be in hospital 3 times a week. I'm going to try to dialyse at least every 2nd day nocturnally. If my fistula can handle it I might even try short daily runs. But i'll work it out later. I don't really want to rely on the hopital. In this area we have Westmead hospital or blacktown regional dialysis centre (where i go for PD clinic as well and where i'll be doing hd training).

The eating with fluid wasn't too much of an issue, i had a good appetite when all was ok, it's mostly been since i got sicker. My creatnine is up around 1100, so sometimes the idea of food is just not nice. I've managed to get my urea down to about 30 ish i think (longer dwells on machine) but my neph said the longer dwells isn't affecting my creatine (one of the side effects).

At the moment i don't really have many diet restrictions. I try to avoid too much protein as it makes me sick but when pd was ok my potassium was too low, protein ok i just had to avoid salt and take renagel (6 a day!) but now i'm also low in salt so Doc gave me a free pass to eat hot chips when i feel like it. He actually asked me if i'd been craving them and told me to go ahead till he saw me in december (though i know not to go overboard). I guess i have to relish till i get on HD that's also why i want to do home HD, so i have less restrictions. Too much life to live to worry about every morsel I put in my mouth, i think self cannulation is worth it to be able to eat what i want. That's also the brilliant thing with pd you can manage your own treatment. feel good, skip an arvo bag to go out. Feel not so good chuck an extra bag on the cycler. I'm lucky my cycler memory card didn't work in my last two machines so the nurses got used to me looking after myself and don't ask for it now. I only see them for my transplant bloods. My hd nurse has pretty much the same attitude, if your capable just go for it and manage yourself.... she's happy for me to do as much hd as i want.

Jeez, 3kg is a huge amount of fluid. You would have had to do all 2.5% to get rid of that... must have been one good night though! it's worth it occasionally. I go through stages where i don't drink for months then i feel like cutting loose so i have a couple, but it doesn't take much anymore. All our neighbours are pretty big drinkers and pretty much everyweekend there's a gathering at one of the houses, so i'm normally the sober one.

Jen