Green bags versus BP meds

[Deanne]

I was / am using one green and one yellow bag on the PD cycler at night, 5 liters of green and about 3 liters of yellow. With that, I need to take a low dose of BP meds every day. One of the dialysis nurses said she thought if I went to all green for a couple of nights, I could probably eliminate BP meds. A neph (not my usual neph) was in the room when she said that and he agreed. I tried it. It's true. However, when I return to one green/one yellow, it's only a couple of days before I need to resume BP meds. I mentioned this to my regular nurse and she said that while it's true I might be able to come off BP meds entirely if I use all greens, it might be better to stay on my original prescription with a low dose of BP meds to maintain my peritoneum. I'll ask my regular neph about it when I see her again, but that probably won't be until late January or February.

To make it more interesting, after I used all greens for two days in a row, my UF has been dropping. For a while I had a UF of 1300 on one green/one yellow. Every day since then with one green/one yellow, my UF has dropped a bit more. It's around 600-700 now with one green/one yellow. I used two greens last night and had a UF of 1300. I'm not sure if the low UF is a problem. I still urinate and I don't feel like I'm retaining a lot of fluid, but ny weight has increased a little bit, so I miust be holding it somewhere.

Is there a general consensus? Which would be better - all green bags more often, or stick with green/yellow and stay on BP meds? Does it make a difference that it might (should) only be short-term? The transplant wait-list here is 2 - 3 years and I've been listed for nearly 28 months with blood type A and PRA of 0.

[Joe]

Deanne, How much has your weight increased? My Neph told me that anything more than a pound in a day would indicate that I was retaining fluid. If you are maintaining your weight, then you are getting everything off with the combination of urinating and PD.

[amanda100wilson]

It is possible to retain fluid and not show it in normal places such as ankles.   How long have you been doing PD?  are the BP meds causing problems?  How about a compromise with the bags?  One green, one yellow one night, and two greens the following night?  That may eradicate the need for BP meds and keep your UF high enough to get rid of fluid?  Have you noticed that you are peeing more?  That may account for the low UF.  Just some thoughts.

[Weggy]

I retain fluid in my abdomen and it is not noticeable unless I consume a lot of fluid. My legs/ankles never swell. It could be possible you are retaining fluid in that location or in another location. Weight gain could be actually weight? PD does provide a lot of sugar to our intake. I guesstimate that I get 325 calories from 3 exchanges and a 250mL last fill for comfort.

As for a general consensus, it is really up to you on how you want to handle your treatment. I use greens only since yellows do not pull enough fluid off of me. My nurse/doc's opinion is that there is no difference between yellow/green in terms of peritoneum wear. However, frequent use of red will wear it out. My opinion, the less medicine I have to take is better. I'm only taking two medicines at the moment my renal cap and imuran for my disease. I do get iron infusions 1-2 times a year since my iron runs low.

[Deanne]

I think I was/am retaining some water in my belly as you suggested Weggy. In the evenings my PD belt tends to ride up because my belly is larger. The low UF problem on green/yellow seems to be sorting itself out though, so maybe I'll play it by ear and see what happens for a couple more days and then do greens as needed, maybe a couple of nights a week. I don't know why my UF dropped off so far and now has increased again. The only thing I can think of is that my body wants to hang onto that extra water, so my UF dropped to return it to where it wants to be.

[Weggy]

Maybe you have low UF because you are not draining completely? I do the manual drain option on the cycler in the morning if I do not have my normal UF amount since I don't drain properly when laying down.

[Deanne]

I think I was draining fully,. I'm on Tidal and sometimes have drain pain in the mornings when I come close to empty. Whatever it is/was, it seems to have resolved by itself. My UF was back up to 1200 this morning on green/yellow. That's normal for me.

[kporter85db]

Your uf will drop if your blood sugar is to high also.

[billybags]

Deanne , Do you carry a extraneal in the day time? If not do you run dry? It is true that greens take off more fluid but after time they could ware down your peritonium more quickly.Your uf sounds really good but make sure you are not getting dehydrated with taking off a lot. Trieing different ways of doing Pd is good .

[Deanne]

I'm dry during the day. I don't have diabetes, and I use Miralax every day, so no constipation. I had a low UF again last night (700-something) and my BP is creeping up again. I plan to use two greens tonight.

I'm curious even though blood sugar level isn't an issue for me - what is the correlation between a high blood sugar level and decreased UF?

[amanda100wilson]

PD works by osmosis and diffusion concentration gradients across the peritoneal membrane, and these differences are determined by the strength of sugar in the bloodstream and the dialysis fluid.  If your blood sugar is high, then there will be a lower difference between the sugar concentrations of the blood and the dialysis fluid.  This will mean that the dialysis will be less efficient and pulling toxins and water out of the blood, across the membrane and into the dialysis fluid.

[Deanne]

I think it was all about sodium. I've been kind of busy lately and got lazy. I started eating more pre-prepared foods. I don't think I was drinking any more than usual, and I don't have any fluid restrictions, so that wasn't a concern, but it was getting so that I was using all green bags more often than not. I started thinking back to what had changed. For a while I was getting a UF of 1200 on one green and one yellow bag and now I need to use two greens for a UF that high. Back when I was getting a high UF on one green and one yellow, I was also drinking a lot of meals in smoothies. I was kind of hooked on them.

I'm trying to cut way back on sodium and I think I'm already seeing a difference after just two days. So if your UF is lower than you'd expect, sodium might be another place to look for the source of the problem.