Fluid retention and dry weight - not right

[whiskeyfrank]

I'm on dialysis after both my kidneys were removed 10/2

Ive been happy on HD however i cant seem to get my dry weight working, they set it at 85kgs, but I'm often only 86 when i go in for dialysis so they take off 1ltr in each session. Im on 750ml of fluid a day so that would be about right.

My problem is i get a lot of fluid in my hands feet and base of my back, last session they took off 3ltrs and that helped but im reticent to do that much again.

I dont know what im supposed to do and if my dry weights wrong, ive got a meet with the manager tomorrow, but wanted the opinions of those who know!

[peleroja]

I would talk to the doctor making the rounds about it.  While I was on HD I was actively trying to lose weight also, so frequently I came in under my dry weight.  I talked to the doctor making rounds and finally they decided to dispense with dry weight altogether.  I'm not sure the manager has anything to do with it.  Be sure and post and let us know how it goes.

[RichardMEL]

You said they took off 3L and that seemed to go ok, but you're not sure you want to do that much again. That would have taken you down to what, 83kg or so? Why don't you use that as your new dry weight and work from that. Did you cramp? You should note your blood pressure during sessions where they pull more fluid and as soon as it starts to go down or you feel faint or something tell them to stop. That will mean too much has been taken. Clearly though if you're still observing swolen parts of your body then you're carrying fluid still and that should be taken off. Did they take 3L because you asked them to or because they noted the swelling?

I would talk to the neph and explain the situation. Perhaps the best bet is to inch you down  by say an extra 300ml or 500ml a session (rather than something much larger like 3L). So you start at 85, next session drop to 84.5 - if you come in at 86 that's only 1.5 off(plus washback) and should be do-able. Then next time drop it to 84.0. Get to a point where you feel comfortable (and not cramping or seeing your BP shift wildly) and you'll be at a healthier dry weight - specially if you're not retaining fluid noticably. It might take a bit to go down by 0.5(or less) per session, but it will be gentler on your body rather than pulling large amounts - unless you're having trouble breathing or anything like that.

You just started a month ago so you're still stabalising and trying to work out stuff like the dry weight. Seems to me that you know when you've got too much fluid on by the swelling and you want to get that extra off - which is great - so work towards that.

[whiskeyfrank]

Thanks for your knowledge, i am new to all this but sometimes i think the techs are too. I asked them to take more off last time as they wanted to take of .5ltr when i was very swollen, they have worked me up from 1ltr to 3 ltrs slowly but they always seem to want to take less fluid off.

I think after what you have said to speak to the neph and see what he says and keep talking off what i think.

[qwerty]

Sometimes we will "challenge" a pt's dry weight by 0.5kg each treatment to readjust edw. Say you took 2.0kg off today and no cramping or hypotension then next treatment we would attempt 2.5kg. If no cramps or hypotension, next tx we would go 3.0kg. Once you begin to cramp, show signs of hypotension or just feel washed out after your treatment then we know we hit the mark and will back down 0.5kg. Usually this helps with adjustments. I always review EDW on a monthly basis as some gain or loose "real" wieght depending on thier diet, holidays, etc. Maybe suggest a challenge but dont do more than 0.5 at a time. Also if your still having swelling another consideration is your albumin level. Not likely the cause but it can contribute if low.

[thegrammalady]

you've got to remember that a dry weight is nothing more than a wild guess. and that no one ever weighs the same thing from day to day. it can even fluctuate from hour to hour. swelling is a sign of fluid retention, i'm willing to bet the farm your dry weight is wrong. i keep a list of how much i weigh when i leave and how much i weigh when i go the next time. that way i know exactly how much i've put on.

[Wallyz]

If you are swelling, or have  alot of mucus and saliva within an hour after dialysis, you can take off more.  Don't lower you dry weight more than .5 a session, and you should be good.   You tell the techs what you are taking off, don't let them tell you.

[whiskeyfrank]

I met with my doctor last night and he feels that with a low HG (7.6) and an albumin level of 28 might be contributing to the swelling. He also feels that as i use 10mg of amplodopine that will also cause some fluid retention.

However last night i found myself very breathless during the night and having to gasp for breath, so im thinking i might have fluid on my lungs now. Bizarrely I'm fine now and in work 6 hours later, so i just cant get my head round this at all.

Ive taken notes of how much fluid Ive taken of each time for my last few sessions as below,

.5kg
1kg
2kg
1kg
1.5kg
2.5kg
.6kg
2kg
1kg
1.5kg

Should i just keep going up by.5 each time until i get cramps or just guess what to take off? The techs just ask me what i think should come off, they reccomend based on dryweight.

so confused!