Green vs yellow on removing toxins (CAPD)

[marlinfshr]

Does an exchange have to remove fluid in order to remove toxins?

I am currently doing manual CAPD. I was at 3 2000ml bags/day and now am at 3 one day and 2 the next, hopefully going to 2/day with my next tests.

I have read that the stronger bags (such as red) can damage the peritoneal membrane in time making PD impossible. I still urinate normally so have not used a red bag. I mainly use green but if my blood pressure both sitting and standing is below 120 I will use a yellow bag. I would like to take it easier on the membrane and be able to continue with this PD until I get a transplant (whenever that may be) because with just a couple exchanges per day on PD I can return back to work next year fishing.

I know a green bag normally pulls off around 500 ml with a 4 hour dwell, however the yellow bag usually pulls off none. I am a quick absorber and if I let a yellow bag dwell for 4 or more hours I may only fill 1800 ml in the bag, so I try not to let it dwell too long so I can at least pull out the 2000 I put in.

Do you think it still pulls off any toxins?

The nurse has told me that I could go ahead and use only the green but in training she said to use the yellow if my blood pressure was lower. Again, I don't retain any fluids. I am just paranoid about doing any harm over time and want to use whatever is easiest on my body so I don't have to go back to HD.
My tests have come back real good and I use only the green leading up to it including the bags I must take in. I also feel great on all other days so that probably answers my own question but I'm wondering if I'm even accomplishing anything when I use a yellow bag.

Perhaps I'm just over thinking this whole thing.

[cassandra]

Maybe you are overthinking        I think the red, yellow, green is more on liquid removal.
Even when you don't remove liquid , you'll remove toxins.

Take care, Cas

[okarol]

Jenna is only using 2 exchanges of 1200 from yellow bags now. She does not retain fluid and she keeps the dwell for 4 hours. She is new to this so we don't know her absorption level. She is to use the green bags if she has swelling or weight gain or high blood pressure. So far she has not used any greens or reds (she started about 7 weeks ago.)
So I don't know the answer in your case, but I believe toxins are coming out with the yellow bags for Jenna.

[marlinfshr]

Thanks for the reply's.
This is still new to me as well. Maybe 2 full month's now of PD. I remember when training that I was told to use the bags based on blood pressure and/or swelling. I generally have higher blood pressure though it's medicated and continues to come down since I've been on PD. I would not be surprised if my cardiologist pulls me off of it, which he said previously he may.
I'm just wondering why I'm told to just go ahead and use all greens. Sometimes I wonder if they just refuse to believe that I still make plenty of urine, even when they receive a full jug come test time.
It's just strange to me when I put in a 2000ml bag of green and a few hours later pull about 2500ml's off and when I use a 2000ml yellow bag only pull off maybe 1800 to 2100 ml's. I guess that's how this mystery fluid works. I mean, I really don't understand how it gets the toxins out but it must be because I feel a lot better then when on HD. I guess that's mainly because I don't have them sucking out all my fluid and leaving me with cramps and a headache. I really don't want to go back there!

[Weggy]

Thanks for the reply's.
This is still new to me as well. Maybe 2 full month's now of PD. I remember when training that I was told to use the bags based on blood pressure and/or swelling. I generally have higher blood pressure though it's medicated and continues to come down since I've been on PD. I would not be surprised if my cardiologist pulls me off of it, which he said previously he may.
I'm just wondering why I'm told to just go ahead and use all greens. Sometimes I wonder if they just refuse to believe that I still make plenty of urine, even when they receive a full jug come test time.
It's just strange to me when I put in a 2000ml bag of green and a few hours later pull about 2500ml's off and when I use a 2000ml yellow bag only pull off maybe 1800 to 2100 ml's. I guess that's how this mystery fluid works. I mean, I really don't understand how it gets the toxins out but it must be because I feel a lot better then when on HD. I guess that's mainly because I don't have them sucking out all my fluid and leaving me with cramps and a headache. I really don't want to go back there!

Red, green and yellow are identical besides the dextrose concentration. Dextrose is a sugar and the reason why PD solution pulls water from your body. Water is removed from your body to the solution via osmosis. Essentially, the solution is a higher concentration of sugar than your body and water will go through your membrane into the solution. Overtime, the sugar is absorbed into your body and the concentration levels out and water will be reabsorbed into your body. How fast this happens depends on the person.

Toxins are always transferred no matter which solution you use. Toxins are removed via diffusion. If you look on your PD bags, it shows you the concentration of certain ions/compounds (and some are not present like potassium (K)). I believe these concentration amounts are set so you have the right level inside of your body. Diffusion is the transfer of a higher ion concentration (your body) to a lower ion concentration (solution).

Personally, you should pull off the amount of fluid you are comfortable with based upon how much fluid you consume. If you are urinating a lot, which seems like you are, you can probably hold back on using the green solution. If you need to pull extra off, use a green. That is one of the benefits of doing home dialysis. We can be flexible. Anyways, always discuss your treatment ideas/changes with your nurse/doc.

My advice on using the red bag, stay away from it. It wears out your peritoneum faster if you use them frequently, but every now and then will be okay. Secondly, it was very uncomfortable to use the red bag. In fact, I have zero 4.25% solution at my place because I will never use it again. It is probably because I pulled off nearly 1L of fluid when using the red bag.

As far as green bags wearing out your peritoneum. I asked my doctor/nurse the same question and they said that it really doesn't effect the lifespan of the peritoneum.

I do 3 exchanges with 2.5% on my cycler every night. Pull off about ~1400mL of fluid a night. Some nights can be higher (1600-1800).

I have been off my BP meds for 1 year and I am glad I am off of them. My BP dropped a lot when I started PD and I was getting dizzy all the time. Another side effect of the BP meds was swelling in my feet. As soon as I was off of my BP meds, my feet immediately stopped swelling up. My BP usually runs around 117-123 over 80-82.

[marlinfshr]

Thanks for the explanation. It helps me understand a little better as I'm still learning.

[Garrett]

thanks
This is a great thread and answered a question for me (am I using too many greens?)

[Charlie B53]

PD woroked very well for me for 3 1/2 years until an itty-bitty 'bug' tried to kill me.  The persistant infection caused me to lose my cath and have a Hemo cath installed.  I'm doing fine.

When doing manual exchanges I also noticed a 4 hour dwell I would absorb some of the fluid.  Remembering seeing a chart during training that showed a 2 hour dwell for yellow, I started shortening the dwells to 2 hours.  No more absorption, and actually started getting positive uf's, usuall only one to 300 ml.

Weighting myself Religiously morning and night, using that number plus my BP to determine if, or how much fluid I needed to take off to decide whether to use yellow or green bags.

PD and the gentle removal of excess fluidis daily is far far easier on the body.  Hemo's rapid fluid removal shocks all the body systems.  Add the need to removal a couple of days accumulation of fluids it's a wonder far moroe people are not opting for PD, if they could.

[jcanavera]

If you can move to a cycler rather than do manuals, you have a lot more control of the fluids  Right now my wife uses 3, 6 liter bags plus a 2,000 ml bag.  We use green and yellow bags making adjustments based on her weight and blood pressure.  The other nice thing is if you are on 3 bag treatment, you can mix fluid strengths on two of the three bags and get more options.  Like right now we have a yellow as the heater bag, and the every other night we use two yellows or a green and a yellow.  Those two bags are on a Y connection which mean both bags are being emptied at the same time.  So you could put a red and yellow together and effectively get the same results as two greens, or you could put a red and green and get a mixture a little stronger than greens but not as strong as reds. 

Typically they usually tell you to put the strongest bag on the heater line and the other two bags come into play after the heater bag is exhausted.  We use the weakest bag on the heater and allow the other two to have the color mix.  Much more gentle on the peritoneum that way.  Plus if you run short of green, you make a green with the red and yellow mix.  Our nurses who take care of us are pretty lenient regarding allowing me to make the fluid choices.  We've got it down pretty good. The key is the blood pressure and weight.  Using manual CPD is not as flexible as the cycler.

Jack

Jack