How much fluid can you tolerate being taken off?

[Mr Pink]

Well, it's yet another night in the chair for me, and thanks largely to some over indulgence over the weekend, I'm having 5 litres removed during the course of my 5 hour shift. Half way through, I'm thinking that they may have to lower it a tad by the time I'm finished. How much fluid can you tolerate being taken off in one sitting?

[cattlekid]

When I was in-center, 3 liters was my absolute limit but I felt like a limp dishrag afterwards.  Anything under 3 liters and I was fine.  When I was home with NxStage, I stuck to 2 liters max (3 hour treatment) and there were often days when I took off no fluid at all.  Disclaimer:  my dry weight was 94.5 kilos, so I'm no petite flower.   

[KatieV]

I can take a max of 2.5 liters off without feeling awful.  Since I'm on NxStage, on the rare occasions that I'm over that, I only take off 2.5.  There is always tomorrow to take more since I dialysize 6 days a week!  I've found lately that I'm not cramping, but get headaches, am dizzy, and my pulse goes through the roof.

I had 4 liters removed recently after a week of not dialysing (access & communication issues).  I got very sick with a migraine and was throwing up.  I felt awful for days.  I think part of that was shock from all the toxins leaving.  Hopefully you have a larger tolerance! 

Cattlekid: I laughed about the petite flower!  I joke with my husband that I'm a delicate flower, but I'm 91 kilos and should be less!

[Adam_W]

I can only handle taking of 3L in one treatment. I was pulling of four one day because I had a lot of fluid on and I was not feeling well, but suffered through it since it was better then having pulmonary edema. One of the techs asked me "So, are you still beating yourself up over there?" I responded "Yup, it's better then beating myself up with lungs full of fluid". 

[cdwbrooklyn]

When I was in-center, the most I’ve removed was 4L. I really didn’t have a problem with feeling bad but occasionally I will cramp really bad.  The least I’ve taken off was 1L when I really didn’t drink that much.   Now that I’m on NxStage, the most I take off is 2.5L occasionally on the days I was really drinking a lot; but I normally take off 2L after a day off and 1.5L– 1.0L the rest of the days.     

[Sugarlump]

3.5 litres in 3 and a half hours is about my max.
Any more in one session and my blood gets too thick and causes problems on the machine 

[amanda100wilson]

That is a lot to remove.  In fact, anything over 05/hour is a lot because there is insufficient time for movement across the cell membranes.  Not only does it put you at risk of cramp, it also is not particularly good for he heart, either, either from carrying the excess fluid or pulling it off too quickly.

[Riki]

I never do more than 3 litres.  If I do, my bp drops like a stone.  I rarely take off more than 2.5 litres per treatment, because I watch my fluids so closely.  I know that I can only handle 3, so I try not to go up more than 3 between each treatment.

[PatDowns]

That is a lot to remove.  In fact, anything over 05/hour is a lot because there is insufficient time for movement across the cell membranes.  Not only does it put you at risk of cramp, it also is not particularly good for he heart, either, either from carrying the excess fluid or pulling it off too quickly.

Mr. Pink (and others) - Amanda100Wilson is dead on about this.  Rule of thumb is to keep your Ultrafiltration Rate (UFR) no higher than 10 ml/hr/kg. 

Here's a good discussion on UFR from Home Dialysis Central (the info is valid for in center patients as well):

http://forums.homedialysis.org/threads/3359-Do-You-Know-Your-Ultrafiltration-Rate-(UFR)?s=ecf57b8a08019df26e24a72d90fce681

From the article: "The effect on mortality of ultrafiltration rates increase dramatically once it is above 10 ml/hour/kg. The calculation is quite easy to do. Using an example of a dialysis patient who weighs 70 kg, dialysis for 4 hours and takes off 2 liters of fluid, we have: 2000 ml/4hr/70 kg = 7.14 ml/hr/kg. However, if we look at a 70 kg patient who dialysis for 3 hours taking off 3 L of fluid, the calculation changes drastically: 3000 ml/3hr/70 kg = 14.3 ml/hr/kg. Shortening the dialysis time and increasing the amount of fluid taken off with ultrafiltration now places the patient in a higher risk of cardiac and all cause mortality."

[YLGuy]

3.5

[ChrisEtc]

I've taken 6.5 off before.  Usually I take off between 4.5 and 5.

[Mr Pink]

Surprisingly enough, I made it through to the end, although my bp was pretty low when I came off. The nurses have been on my back about my fluids. I'm trying to stick to drinking 1.25 litres a day, but it is hard, especially when I used to guzzle over 5 litres a day, and considerably more than that on Fridays. I'm a solid lump of a lad, weighing in at 110kgs, at 5'11'' and visiting the gym two to three times a week. I am transplant listed, although my surgeon did say that I'd have a better chance with a new kidney if I got down to 100... which I am working on. 

[Weggy]

When I was doing in-center, the most I ever took off was 5.5L. However, that was when I started dialysis. The hospital put 45 pounds of fluid on me in 10 days because they were giving me saline via IV. I had to request to take off more in a session because my legs/ankles were so swollen and I wanted to get rid of the excess fluid. After getting rid of that excess fluid, I usually took off about 2.5-3L per session. Looking back on it, the 2.5-3L was too much since I was going below my dry weight because I was gaining weight. If I had to do hemo again, I would be more assertive on what needs to be taken off.

Side note, I had someone next to me put on 10L of fluid between sessions...he looked miserable.

[kitkatz]

4.5 to 5 L regularly

[smcd23]

When Tony came home from the hospital last June after the failed transplant, he had about 30 to 40lbs of fluid on him. It was awful, he has stretch marks on his legs from all of the fluid. So obviously #1 priority was getting it off, so he had his first session the day after discharge and they took off 5L over 4 hours. Then they gave him a "bonus" session on Thursday and they pulled 5L off in just over 2 hours. That was intense, he needed oxygen because his blood pressure tanked, but they wanted as much fluid as possible off for the weekend. Normally he can't handle more than 3.5L which is his average weekend gain. During the week he maybe gains 2L.

[Dragonfly]

Well, it's yet another night in the chair for me, and thanks largely to some over indulgence over the weekend, I'm having 5 litres removed during the course of my 5 hour shift. Half way through, I'm thinking that they may have to lower it a tad by the time I'm finished. How much fluid can you tolerate being taken off in one sitting?

The max I can tolerate is 3.5 and of course they always try to push for more, then I ask them if they want me to leave by ambulance, because I don't.

[deniferfer]

I'm new to hemo but I have been able to handle 3.5 kilos but that was also the highest I have been over and i don't want to go higher to break any records. lol

[dialysis.sucks]

No more than 3 kilos. No matter the amount of time or the amount of water im holding. For example Im probably 10 kilos over right now, but that means I need to pick up extra treatments because I cramp inside of my knee if I ever go over 3. Yes, INSIDE, my knee. It's horrible. They end up having to put liters back into me.

[Grumpy-1]

The max they have taken off me is 5 liters one day, 5 liters the next and 4 liters the third day.  BUT I sure felt it later.  BP dropped like a rock and I was light headed and dizzy (more that normal) for hours.  Now back on the regular schedule of 3 sessions a week, they take off 2.5 to 3 liters.  Grumpy

[pagandialysis]

Well I usually put on 1.5-2.5 and make sure they never take more than 3.5 off of me at a time so I don't cramp. I have once taken 5 off and it was hell.

[RenalSurvivorDotCA]

When I was in-center I used to take off 5L in 5.5 hrs. I would use a linear UF profile so rate was 1300ml/hr at start and ended up something like 600 or 700ml/hr in last hour.

I'm on home hemo now doing 5 nights a week. I never have more than 3.5L to take off. And that's over 6.5hrs so UF rate is very gentle.

[Sugarlump]

I really wish I could get more than three sessions a week.
(They won't let me do home haemo yet because of access problems with a femoral line)
I would prefer 5 shorter sessions than 3 x 3.5/4 hours a week.
Be kinder on the body.
But availabilty is not good in the UK for extra sessions.
I am always thirsty. 

[NDXUFan]

Surprisingly enough, I made it through to the end, although my bp was pretty low when I came off. The nurses have been on my back about my fluids. I'm trying to stick to drinking 1.25 litres a day, but it is hard, especially when I used to guzzle over 5 litres a day, and considerably more than that on Fridays. I'm a solid lump of a lad, weighing in at 110kgs, at 5'11'' and visiting the gym two to three times a week. I am transplant listed, although my surgeon did say that I'd have a better chance with a new kidney if I got down to 100... which I am working on.

Try Home Nocturnal Dialysis, 6x per week, your fluid issue will cease to exist.  I was just like you, I could guzzle five liters per day.  I would reduce my dry weight by .3 per day on Nocturnal as recommended by the Indiana University Nephrologist, worked very well. 

[doberose]

Although I've only been on ICH for about 3 months, I haven't gone over 2,1L for 3.5 hours.
At my last treatment I started to cramp at 2L and had it reduced to 1.7L.
My weight is around 75 kilos, so the UFR is in the safe zone -- under 10.

[Dman73]

I try to keep it under 3Kg for a 4 hour treatment.

I got into trouble once with fluid overload where I had to get admitted to the hospital
and they told me that my heart was like a over-inflated football and the valves reversed themselves.

I spent 3 days in bed with a catheter in my groin up into my heart where they were giving me aggressive dialysis to remove fluid and try to normalize the heart & valves.

After that experience I try to keep my weight gain around 2kg which sounds like not much but is over 1/2 gallon of water. I wish they would use pounds instead of kilo's for dialysis patients because the pounds number sounds greater.