Tell me about Number One

[okarol]

 

[nycrtst85]

Thnk God i have not stopped peeing.I noticed though that when i wasnt taking care of myself{mostly not following the diet} my phosphorous and pottassium was high i could not pee as well but now ive been following the diet and take fosrenol for my phosphorous and take in natural medicine to cleanse my system out i noticed and increase in urine flow like a lot more than before.

[Bub]

I know this subject has been discussed alot, but I cannot find the answer I am looking for.
Which is it? Is the urination declining because the dialysis is successfully removing excess fluid?
Or is the kidney failure causing less fluid to be processed and it gets backed up in the body?

I asked a neph what is it about dialysis that has made me quite urinating.  She replied that dialysis is not the culprit, rather it is the natural progression of the ESRD that put me on dialysis.  Right now I go only once a day usually in the morning, but I still go through periods where I do produce quite a bit.

[okarol]

Does Every Dialysis Patient, at Some Point, Stop Urinating?

From AAKP

At some point, most dialysis patients will stop urinating, but the rate of decline in urination is different for each patient and is dependent upon the type of kidney disease as well as the type of dialysis modality employed. Generally, patients receiving hemodialysis (HD) lose their ability to urinate faster than patients receiving peritoneal dialysis (PD). This decline in urinary output has various implications on patient management and survival.

Patients who continue to urinate while on dialysis (HD or PD) are said to have “residual renal function” (RRF), and this factor is an important consideration in their management. Dietary restrictions on sodium and fluid intake can be liberalized to some degree. Depending on the degree of RRF, less dialysis therapy may be indicated. Nevertheless, close monitoring is needed because kidney function tends to decline over time. Recognition and acceptance of this fact greatly facilitates individualization of dialysis therapy. Studies also suggest dialysis patients, who have RRF, have a greater likelihood of survival than patients who do not. In PD patients, RRF declines steadily by 1.2-2.8 percent per month, irrespective of the underlying kidney disorder that initially led to dialysis2. This survival advantage falls in tandem with declining urinary output.

Similar survival benefits have been shown for HD patients. A Netherlands trial (NECOSAD-2) showed a 56 percent reduction in death in HD patients who had RRF3,4. Similar results were shown in a study conducted at Brown University5. HD patients lose RRF at a faster rate than PD patients; about 5.8-7.0 percent per month, irrespective of the underlying kidney disorder2.

Although PD patients lose RRF at a slower rate than HD patients, the likelihood of survival on either dialysis modality over a five-year period is comparable. Therefore, it would not be advantageous to change from HD to PD despite the differences in RRF.

For those on dialysis, significant RRF permits patients’ a degree of denial about the severity of their kidney disease. As long as a patient has some RRF, it permits the notion that kidney function may recover. As such, a patient may deny that dietary restrictions and dialysis prescriptions are fully applicable to their situation. The consequences of this denial can result potentially in significant morbidity. Conversely, the loss of RRF forces a patient to fully confront the stark reality that he/she is dependent on dialysis and must be fully engaged in appropriate lifestyle and dietary modifications.

Recommendations for stopping the decline in RRF are limited. It is not clear why RRF decreases once patients start dialysis, nor why there is a difference in RRF between HD and PD patients. However, it is safe to assume in most instances there is inexorable progression of the underlying disease process itself. Some general guidelines to slow the decline in RRF include:
1) Vigorous blood pressure control, 2) The use of angiotensin-converting enzyme inhibitors (ramipril, enalapril, lisinopril) and angiotensinreceptor blockers (losartan, valsartan, candesartan), and 3) Avoidance of kidney-toxic agents (non-steroidal anti-inflammatory agents, aminoglycoside antibiotics, iodinated contrast agents used for Cat Scans)2. Because each patient is different, it is important you speak with your physician regarding the applicability of these recommendations to your situation.

More research needs to be done to learn the importance of RRF in patient survival.
Generally, patients who begin dialysis will notice a steady decline in urination (and RRF) at varying rates. Survival is improved if RRF is preserved for patients receiving PD or HD, but RRF alone does not make one form of dialysis better than the other. With additional research, we will know if it is important to direct our therapies toward preserving RRF at all.

References:
1. Bargman JM and Golper TA. The Importance of residual renal function for patients on dialysis. Nephrology Dialysis Transplantation, 2005. Volume 20: pp. 671-673.
2. Jansen MAM, et.al. Predictors of the rate of decline of residual renal function in incident dialysis patients. Kidney International, 2002. Volume 62: pp. 1046-1053.
3. Termorshuizen F, et.al. Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients: An analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2. Journal of the American Society of Nephrology, 2004. Volume 15: pp. 1061-1070.
4. Termorshuizen F, et. Al. The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life: an analysis of the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD)-2. American Journal of Kidney Diseases, 2003. Volume 41: pp. 1293-1302.
5. Shemin D, et.al. Residual Renal Function and Mortality Risk in Hemodialysis Patients. American Journal of Kidney Diseases, 2001. Volume 38: pp. 85-90.

James Bailey, MD, is a professor of medicine in the division of nephrology at  Emory University and head of the renal fellowship program.

Tejas Desai, MD, is a Nephrology Fellow in the Emory University Division of Nephrology. His academic interests focus on Internetbased medical education for physicians in-training and dialysis patients.

This article originally appeared in the November 2008 issue of aakpRENALIFE.

http://www.aakp.org/aakp-library/Stop-Urinating/

[nycrtst85]

Hello,i still urinate even more.but what i found is that if you eat what you are not supossed to your urine decreases and you get sick thats why THE DIET IS IMPORTANT.some medications dry up the kidneys,I take natural medicine which makes me pee more feel good and also take fosrenol to keep my phosphorous low.i'm sketched out about some medications i took sensipar and couldnt use the bathroom for one whole day i FREAKED OUT after that i dont trust medications that much but NATURAL MEDICINE IS A WHOLE DIFFERENT STORY>

[sullidog]

After 7 months on dialysis I still uranate 700 ml plus a day. A nurse told me that was very good for a dialysis patient.
Troy

[okarol]

 

[Desert Dancer]

I stopped peeing altogether about a month into dialysis; it was very upsetting because I had expected to maintain at least a little residual function. Then when I got home and started doing nocturnal it gradually started to come back. Now I'm back to peeing 4 or 5 times a day, just like normal. Sometimes in the morning I have to do a little dance while we get me off the machine, I have to go so badly. Obviously I don't have any fluid restrictions at all. I hope it keeps going like this!

[kyshiag]

@nycrtst85 What natural medication are you using?

[peleroja]

I've been on dialysis 7.5 years and have gone from an output of 2600 ccs to less than 100 ccs, but I still pee a little bit every day.

[Riki]

I've been on dialysis this time for not quite 7 years, and I stopped peeing all together about 3 years ago.  In the year leading up to the complete stop, I'd pee maybe once or twice a week.  I remember going to the hospital for clinic and they wanted me to do a 24 hour urine test.  The nurse handed me the jug, and I laughed.  I remember the small celebrations I had when I did pee.  My best friend always thought it was funny when I'd announcer to her, "hey! I peed today!"

I didn't stop peeing before my first transplant.  I think I probably slowed, but I didn't really notice.  I think that between the ages of 12 and 14, you have better things to notice than how much you pee. *L*  I remember, in the days after the transplant, for some reason the nurses had me sitting up on a commode without the pot.  I was still wearing johnny shirts, because I still had iv's and drains and things of that nature.  I was watching tv, and one of the nurses came in.  She asked me if I knew why the floor was wet.  I didn't, but when we looked, the johnny shirt that I was wearing over my back was wet too.  I had peed without even realizing it.  I had to learn how to hold it again.  I'm not really looking forward to doing that again, because it's going to be harder, because I don't pee at all anymore

[Henry P Snicklesnorter]

.

[kamar55]

I've been on dialysis almost 6 years now and still pee, though much reduced. Most folks (both drs. & fellow patients) are very surprised. I estimate I pee under 300ml/day and am grateful for even that bit.

[mamagemini]

I found this thread doing some research. I just noticed yesterday that I did not have to go pee really bad after dialysis. Then this morning, not so much either...got me worried so I researched. I have FSGS/Nephrotic Syndrome so I am not sure this is good? They have started cleaning me at 450 now so it is a better cleaning than before...

[MommyChick]

I found this thread doing some research. I just noticed yesterday that I did not have to go pee really bad after dialysis. Then this morning, not so much either...got me worried so I researched. I have FSGS/Nephrotic Syndrome so I am not sure this is good? They have started cleaning me at 450 now so it is a better cleaning than before...

You should feel better since there cleaning your blood more to get rid of all those nasty toxins!
 I haven't peed in 7 yrs, haha ... I joke with my hubby when we go places, that at least he doesn't have to wait for me Plus I love going places knowing I don't have to use those dirty bathrooms.. I just hope my bladder will know how to work the day I finally do get my kidney!

[M3Riddler]

I found this thread doing some research. I just noticed yesterday that I did not have to go pee really bad after dialysis. Then this morning, not so much either...got me worried so I researched. I have FSGS/Nephrotic Syndrome so I am not sure this is good? They have started cleaning me at 450 now so it is a better cleaning than before...

Mamagemini,

Running you at a higher blood flow of 450 does not necessarily benefit you any more than a lower blood flow.  Remember, Dialysis is only cleaning what is currently in your bloodstream.  Some toxins as well as phoshorus and other middle - larger molecules take time to go from your tissues into your bloodstream. Therefore you are not necessarily getting a better treatment. Plus with the day off and the weekend you are buildup up more toxins so actually there is a net gain over time of the buildup of phosporus and other Beta2m  which can cause bone iissues.

[okarol]

Jenna still urinates, she's been on manual PD for over a year now.
I think she has a tiny bit of function left from her nearly 8 year old transplanted kidney (rejected )
She's still on anti-rejection meds so that may have helped hang on to the last 5%.