1st successful in center D/ low bp after...

[carol1987]

I had my first successful in center HD sessions yesterday. 
It was my 5th dialysis... i had 3 in hospital in October to start and then at first center visit was infultrated.  My pulminary surgeon operated on my fistula to raise it and I went without D while I recovered.   Started again on Tuesday in Hospital and it went well...
I was concerned about going to the center but it went pretty well.   Accessed easily and seemed to go well... until they had me do the standing BP at he end... I came very close to blacking out.. my hearing even got weird....  I was taken off at 9:30 AM and left after 11!! 

I still feel weak and lightheaded today... Is this normal??

[boswife]

From what we've learned, thought it's not ideal to feel that way after D but it is quit the norm until your body adjusts to it.  There are a lot of factors involved later, like too much water taken off and stuff, but beings this is your 'beginings' it sounds pretty normal to me.. Others input will be good though.. Congrats on a good session though.  Glad that it mostly went smooth for you though.. It'll gett better and better..

[carol1987]

Thanks Boswife and congrats on your news about the nxstage.... good luck with training!

[greg10]

I had my first successful in center HD sessions yesterday. 
It was my 5th dialysis... i had 3 in hospital in October to start and then at first center visit was infultrated.  My pulminary surgeon operated on my fistula to raise it and I went without D while I recovered.   Started again on Tuesday in Hospital and it went well...
I was concerned about going to the center but it went pretty well.   Accessed easily and seemed to go well... until they had me do the standing BP at he end... I came very close to blacking out.. my hearing even got weird....  I was taken off at 9:30 AM and left after 11!! 

I still feel weak and lightheaded today... Is this normal??

Welcome to the forum, carol, and you are right to question what is happening to you.  Boswife is right in that you are having fluid removed from your body, perhaps due to your time without dialysis.  This process of fluid removal is called ultrafiltration (UF or QF).  Sometimes too much UF too fast will result in the blood pressure falling too much too fast and may result in the patient "crashing".  To avoid this problem, UF should be carried out no faster than 10 ml per kg weight per hour.  That is if you are 70 kg, you should not remove more than 70x10 or 700 ml of fluid per hour in UF.  Let your dialysis nurse know that you don't want a UF "profile" that exceeds this number per hour.  Many times the dialysis center will try to get you to your dry weight as soon as possible and may exceed your UF limit.  There is no need to reach your dry weight the first time you dialyze.  In fact the dry weight is a theoretical number that the nephrologist guess-timate and may be a moving target that should be approached gradually.

[Riki]

it happened to me several times in the beginning.  That was 2 years ago, and it hasn't happened to me in a long time.  After a while, you know what your limit is, and as long as you don't have more than your limit taken off, you should be fine.

[brandi1leigh]

I've been incenter almost a year, and unfortunately, this still happens to me at least once a week. For some people it takes longer to adjust, at least that's what they keep telling me.

[carol1987]

Thanks everyone...   Greg10  I think they only took 600ML off.... but I am not sure...
I thought I prepared but there is so much to learn. 
I don't think I have been retaining much if any water. My weight was the same from the last dialysis throughout my month off...   would that mean I was not retaining water?

[Bruno]

Hello Carol, it's good you have made a start...I'm 4 months since my first dialysis but I can tell you that the first 4 weeks you gradually feel better and better as your body adjusts to what is happening to you and the medical staff and nurses work out the best way to handle your particular issues. Everyone is different is what I had drummed into me from the first day. Fainting...I used to pass out going on, in the middle and coming off. Fluid...they used to take off too much until they worked out I couldn't handle it...my limit is 400 per hour. But don't forget, fluid is not the only thing you do on dialysis...you are getting those nasty toxins out of your body as well.
I promise you you will feel better as time goes by and your bad episodes will eventually disappear.

[greg10]

Thanks everyone...   Greg10  I think they only took 600ML off.... but I am not sure.....

As a dialysis patient, it is your responsibility to know your own weight and keep track of how much you put on and how much the dialysis treatment is taking off.  Invest in an accurate scale with kg calibration at home and use it often.  For water, kg translated directly to liters, so 1 kg = 1 liter.  Keep a log of what you are gaining and losing through fluid intake and dialysis.
As many have said in this forum, every dialysis patient is different, but your weight will guide you to your UF limit.  The example I gave above is for a person 70 kg.  You could weigh 35 kg and your limit could be 350 ml per hour.  That number doesn't guarantee you won't crash, it is just a guide to the approximate safe UF rate.

In general, the longer and gentler the dialysis, the more benefit it is to the patient because it mimics the way functional kidneys are supposed to work, which is 24x7, working gradually.  Some patients on this forum are running 4, 5 or 6 days a week for up to 8 hours each treatment.  They are often doing this at home and some nocturnally.  Think of the in-center day treatment of 3x3 (thrice a week, 3 hours each time) as a minimalist-rushed treatment that is limited or defined by the time and cost structure to the in-clinic treatment system.

Altering the way you do dialysis will allow you to be more flexible in your fluid intake and fluid removal through dialysis (UF or ultrafiltration) and through any remaining kidney urine production.

[Stoday]

In a couple of months or so you'll get to know your limits in terms of the maximum fluid that can be taken off in a session. My limit is 3 liters; if I exceed that I get cramps during and after the session. Yiou also get to know the feeling when your blood pressure is falling too far in time to attract attention. If you have a problem attracting attention, kink one of your blood lines to trip the alarm on the machine (don't clip it off! You might black out).

[rsudock]

Greg you have such great advice and everybody has been really caring on this thread. I have been really sick lately on D with the allergic reactions and trying to take to much fluid off. Somedays I take 3 liters off and I am fine other days I am sick as a dog....I guess I am going to watch the fluids more closely. Still trying to figure out this dialysis stuff...seems so up and down all the time.

Carol hang in there, everyday is a fight and we are the soilders on the front lines! We can do it!

xo,
R