Washout symptoms when no fluid taken off?

[Woofgang]

Hi all. My DH is new to dialysis and has had some fairly extreme washout symptoms (the flu like set) I have googled and find this is usually due to taking off fluid too quickly or too much BUT he is still peeing plenty so they don't take any fluid off and he is still on free intake. he has also had episodes of low BP.  We are in the UK. We are sure that no fluid was taken off as his weight didn't change after dialysis.
Any comments or advice appreciated. he is anaemic but delaying having Epo because of other medical issues.
Thanks

[kamar55]

Even though no fluid was taken off, he still had the toxins removed and that can cause the "blah" feeling. Also low bp makes me feel that way too. And anemia can cause the washout feeling. As he is new to dialysis, I would give it some time and see if the symptoms improve...

[Woofgang]

Thanks. It wasn't so much blah as exhausted can't sleep, joint ache, what I can only call the jitters and flulike depression.

[billybags]

Woofgang, get them to test for folic acid. My husband has been told he is anemic but his anemia nurse said his levels of iron are well with in the limits of a renal patient.They have measured his folic acid in his blood and it is very very low, so he is now on a folic acid tablet. Apparently it does take a while to make a difference but 2 weeks down the line he is not so tired. Does any one else take folic acid?

[Woofgang]

thank you, will do.

[Bill Peckham]

I'd want to know that the delivered sodium level of the dialysate is at or very near the sodium level of the blood. The UK's own Dr. Andy Davenport presented data at this years Annual Dialysis Conference that a large number of machines (in the UK), when independently checked, were delivering sodium levels that varied widely from what was prescribed. If your husband is being run on a low sodium dialysate bath it could leave him with the symptoms you describe.


It just happened that it was Dr. Davenport who presented the data from the UK,  I think this is a problem across boarders. There is a US abstract that reports the same problem: Edwards C, Singh S, Griffiths M, et al. - Correct Calibration of Delivered Sodium Dialysate Concentration Results in Improved Blood Pressure Control. ASN Annual Meeting -- San Diego J Am Soc Nephrol (Nov) 20:204A 2009:

... As part of a quality control procedure prior to a clinical trial we measured the delivered [Na]d using a flame photometry assay. Dialysate was sampled cyclically over a 6-month period from 71 dialysis machines. 32/71 [35.7%] machines were delivering a mean [Na]d >144mmol/L. The machines were recalibrated with fortnightly assessment of delivered [Na]d until they were at target 140mmol/l within the tolerances of the machine [2 mmol/L].

Post calibration there was a significant decrease in mean [Na]d, 143.52.1 v 141.5 1.4 mmol/L [p<0.0001] and only 6.7% dialysis machines continued to deliver [Na]d >144mmol/L ...

These machines are delivering high sodiums and even after calibration every two weeks 1 in 20 still delivered the incorrect sodium. I think this is a real blind spot, with me and we dialyzors in general - the idea that the device we are relying on is out of calibration - this should be the first place we look. It seems very easy to blame the dialyzor for feeling poorly - it must be a diet or fluid consumption issue - when in fact the data shows that it must be true that quite often the dialyzor is being sabotaged by the device. A high sodium concentration in the dialysate would lead to thirst post treatment and likely mean the dialyzor coming in with too much fluid the next treatment. A low sodium would leave you feeling hungover with a debilitating headache.

[Woofgang]

Thank you .....that's going to make the new boy popular 

[jbeany]

I was told that even when the machines are set not to take fluid off, they still pull a small amount.  It's required by the process the machines use for filtering.  His weight may be the same because of the saline they are using at the end to flush his lines.  But pulling even the small amount of fluid necessary for the machines to work may be upsetting his fluid balance during the run.  Perhaps a tiny bit of saline at the beginning or middle of treatment might help as well?

[okarol]

Jenna was also urinating as normal so it seemed to help her feel better to have some Gatorade right after dialysis to replace salt and electrolytes. Check with your dialysis center to see if this is ok.

[Woofgang]

Thanks for the answers, i wasn't able to log in for a while so couldn't respond.
Here's the next bit of the puzzle. The kidney doc has been telling DH that he is dehydrated and should drink more, this despite religiously taking in a minimum of 3 litres every 24 hours since forever, always a mixture of slightly sweetened tea, juice (cranberry) and full sugar non cola fizzy drinks, this all okay'd by the dietician whose only quarrel with his diet is that he doesn't eat enough fruit and veg. He did look dry, a bit gaunt, thin fingers and very dry skin. Phosphorus and potassium normal (real normal not CKD normal) Since the bad flu symptoms night, he has started to hold an extra litre and a half, taken on over 2 days and not continuing to rise, dropping off a little if anything. he looks and feels better, has certainly slept better, although still feels anaemic, which he is.
Anybody got any idea what is going on please? He will be seeing the doc soon, hopefully today...but well i think I'd like a second opinion from the experts here 

[Woofgang]

A-Ha!!!!!!
DH had a good chat with the intern today at the dialysis centre.
Here's the story
He started dialysis dehydrated which we knew. He has had a long term problem getting fluid to "stick" and not pass straight out again; he was also on fairly tight dietary control made tighter by poor appetite.This was further complicated by a slightly too dry dry weight estimate. He thought they were taking off nothing, but their "nothing" was actually a standard 0.5 litre, a little bit more than the replacement saline, hence the jittery night when his fluid balance got really low, this was after the third session when he was around a litre of fluid short.  Dialysis improved his appetite and the dietician "derestricted" his diet on the basis of excellent bloods and a need for increased protein. The better diet has made fluid "stick"The improved diet (allowed, indeed must have, more protein, more potassium and more sodium!!!!!!) made the fluid "stick" replacing the lost amount and reversing the longtime dehydration.
His dry weight has been adjusted upwards by 2 kg so hopefully that will address the issue.
Got to say i am impressed with his team. they really seem to listen to him, all are aware of his complex medical history. i feel i can trust them with my DH 
Thanks for the gatorade advice...the early morning shift all get tea and toast with jam or marmalade mid session.

sorry for the ramble  as you can guess i am feeling very relieved.

[jbeany]

Ah, good, I'm glad you have answers.  Hopefully, he'll feel better!

[sullidog]

I am in the same vote, machines do have to remove a minimal to clean the blood, but whatever gets taken off needs to be replaced, in fact I have to get flushed every half hour, also I am on sodium modeling which also helps.