Reduced Function

[Vt Big Rig]

I started dialysis 22 months ago. Have always used my residual function to help calculate my clearance. We would collect urine for 24 hours, measure it, and send in a sample. I consistently produced about 1200 cc in 24 hours. We collected once a quarter. Did this yesterday. Oh oh. Production is down to about 400. What will this mean for treatment? I expect they will make me go from 4 to 5 days or longer than my 3.5 hours. Not news I am hoping for!

Never ends does it?

[Charlie B53]

I would have sworn you have been on longer than that.  You have so much knowledge I haven't near learned yet.

I am surprised to learn you produce so much.  When I first started PD getting closer to 4 years ago I was barely making slightly over a liter a day.  Now maybe a half liter on a good day.  And that is taking 120MG lasix plus a metalazone.  I make even less on Dialysis days.

Residual function will continue to decrease, that rate may be dependent on a number of things, including which particular kidney disease you have, the repeated shocks to the kidneys due to some medications, possibly the shock of doing dialysis itself.  There is still so much we do NOT know about cardiac 'stunning'.  It may be found eventually that the kidneys also may be getting 'stunned' and in turn lose a small amount of function.  We don't know yet.

I also worry a bit about losing residual function.  I think even that small amount I have makes a big difference in my phosphorus.  On PD my levels were great, now on Hemo I am eating Binders like candy and my phos is still a bit more than twice what it used to be.

I don't know anything about figuring clearance, you are way more knowledgeable here than I.

[Simon Dog]

I also worry a bit about losing residual function. ...... now on Hemo

My neph told me residual usually completely disappears after 6 months on hemo.    I found the best way to cope with this was to accept that fact as soon as I started the needle.  Turned out he was right.

There was a study done with reducing hemo in the early phases (down to 2x/week) in an attempt to slow the residual decline.

Higher residual is associated with longer survival, but I am coming up on my 5th D-anniversary and I'm still doing well.

[Vt Big Rig]

I also worry a bit about losing residual function. ...... now on Hemo

My neph told me residual usually completely disappears after 6 months on hemo.    I found the best way to cope with this was to accept that fact as soon as I started the needle.  Turned out he was right.

There was a study done with reducing hemo in the early phases (down to 2x/week) in an attempt to slow the residual decline.

Higher residual is associated with longer survival, but I am coming up on my 5th D-anniversary and I'm still doing well.

Yes, I did expect it to decrease but not so dramatically. I just worry about what it will do to my treatment schedule.

About two weeks ago we had a dehydration incident. Still don't know why. Was not going lower than usual. But had the BP crash and passed out. We think that helped kill them off.

We will see .... Clinic next week.

[Michael Murphy]

The other cause could be you have gained weight, if that is true taking you down to dry weight is actually bringing you below your true dry weight there fore your output will drop.

[Vt Big Rig]

The other cause could be you have gained weight, if that is true taking you down to dry weight is actually bringing you below your true dry weight there fore your output will drop.

Actually I have been losing weight . Slowly but steadily. Gotta get to a certain weight to get "active".

[Charlie B53]

Actually I have been losing weight . Slowly but steadily. Gotta get to a certain weight to get "active".

Have you increased physical activity in you efforts to lose weight?

Muscle mass is actually denser than fat.  Losing inches doesn't always appear as a weight loss, it can actually show a gain.

Depending on how much exercise, muscle gain, you may be improving your health but still be causing some dehydration.

I have gotten into the habit of 'pinching' the skin on the backside of my Wife's hand to check and see how quickly it 'falls' flat again.  Any small 'ridge' remaining more than a second or two is a very good indication she is becoming dehydrated.  And I get a big cup of chicken broth into her.  My PD Nurse taught me long ago the salt and liquid in the broth can be absorbed and retain quicker than a glass of plain water.

[apetty]

Have you read about protein catabolic rate?  Activation of inflammation (C-reactive proteins) caused by oxidative stress can cause muscle wasting, so you could be losing weight without dieting or exercise.  Not sure if this is exactly right... but my initial thought is that your dry weight is too high, this frequently happens to me, I'll come in under my post weight, if I try to remove any fluid at all I'll be hungover as hell and my urine output decreases dramatically for a day or two.

[Michael Murphy]

After 4 years I was still putting out all of the fluid I drank.  Then I had  a heart attack with severely limited heart function I began to retain fluid, and at the same time I was hospitalized for about 16 days .  When I went back to regular dialysis I was suffering from fluid build up in my legs and lungs. During the next 4 sessions they took 4 kilos a session off of me plus I went on a 32 ounce  fluid restriction.  Since then I have been going to cardiac rehab and my ejection fraction has doubled.  I have slowly started to raise my allowance of fluids and now I am at 48 hoping to be up to 64 by summer.  Since my input is my out put has gone up to.  Since dehydration causes kidney damage my theory is they tell every one that they are limited to a liter of fluid a day and taking that much off during dialysis kidneys recieve damage from dehydration.  The real rule is 32 ounces above your output.