How long did you figure out your dry weight

[cris]

My Mom is now one year on hemo. when she started she was on 55kg. went down to 51, then 41, stayed for a while, now on 35.5. I understand losing weight is expected but it's been a year and she's still on a seesaw of weight adjustments. She had problems now and then, most recent was the hepa c infection. She would lose appetite but then bounce back after a while. When i went home last july she was in the National Kidney Institute, bone and skin, that was the time the neph adjusted her weight down to 35.5. She recovered, begun to eat a lot, Neph adjusted the weight to a little 36kg but again she got some murmurs in her back, so her weight is being adjusted again to low 34kg. But physically she looks a lot meatier than when she was recently in the hospital, and stronger too. Now she can walk a little, spend sometime in her garden, go to to the mall with my kids. I am scared of her losing weight so much. She does 3x/4hrs every M,Thurs,Sat., runs 200-220 pump, does a rinse on her line every 30 mins, if she doesn't, her blood pressure drops and feal weaken. Regular pull out is 3kls. Lately she did 5kls. She gets epocan shots every once a week and gets an IV nutrients (nephrosteril before but now celemin for the liver). Usually the 1.5 extraction is for the IV nutrients and the rinsing.
I appreciate your thoughts.

[julian230]

I've been on dialysis for almost a year now , and I still scratch m y head at the dry weight. Usually I have it down when they aren't taking that much off me, and I feel like crap. For instance , if they take off 4 kg , and I feel like crap.. thats come to expected because thats alot for me , but if they are taking off 3000 or less and I feel bad , than it means I've reached a dry since that isn't much for me. Plus blood pressure should be a good indicator , so basically 1) blood pressure bottoming out and 2) you feel dizzy or tired , or cramping . Usually when I yawn , my ears will pop like i'm on an airplane!

[jbeany]

Unfortunately, figuring out dry wt is not a science - it's an art.  They can only guess, no matter what they tell you.  What they don't tell you is that it is your right to set your own weight.  Tell them how much you want off - and adjust it according to how you feel - not what the scale says.  If your mom is needing fluid every 30 minutes while she is on - I'd say they are pulling too much fluid, too fast.

[monrein]

It's hard when you're losing flesh weight as well.  Very tricky.  Some people weigh the fluid they take in plus a little for unaccounted fluid from food.

I also watch for cramping as my run goes along.  BP and cramping for me.  I push my toes down all the way along and as soon as my toes feel crampy when I point them I turn the UF to minimum.

[thegrammalady]

i don't pay any attention to my dry weight. it's really just a guess. no one weighs the same thing all the time. i weighed 75.6 when i left dialysis this morning. what we set the machine for friday morning will depend on what i weigh in at.

[petey]

When Marvin first started on in-center hemo in March of 1995, here's how they determined a patient's dry weight:
Hook him up.  Turn the UF high.  Suck him dry.  When he crashes, cramps, and screams in pain and his bp is less than 80/40, flip his chair back so his head is almost touching the floor.  That's his dry weight.

Can you imagine?  After one treatment, Marvin said, "There has to be a better way to determine my dry weight than this!"  He had to argue, argue, argue, but the nurses finally let him have some say in how much to take off each time.  ("This is how we've always done it," the nurses said.  "Always until now," Marvin answered.)

Unfortunately, figuring out dry wt is not a science - it's an art. They can only guess, no matter what they tell you. What they don't tell you is that it is your right to set your own weight. Tell them how much you want off - and adjust it according to how you feel - not what the scale says. If your mom is needing fluid every 30 minutes while she is on - I'd say they are pulling too much fluid, too fast.

jbeany's right -- figuring out your dry weight is an art.  Marvin knows as soon as he comes off the machine that he's at the right dry weight, it needs to go up a little ("dry" feeling), it needs to go down a little (still some minor "fullness"), and he adjusts accordingly.  Also, if his appetite is slack for a day or so, he knows to "challenge" the dry weight and drop it 1/2 a kilo.  If he's been eating like a little piglet (which is now more often the case with him), he ups it 1/2 a kilo.  Bottom line -- it's YOUR dry weight, not the nurse's or the tech's.  Dry weight isn't that ominous cloud hanging over his head now that he's on home hemo (as opposed to in-center hemo).  We can adjust it every day if we want -- it all depends on how Marvin feels and where he thinks it needs to be set.

[flip]

Petey is right, many centers determine dry weight by making you sick. In my opinion, the most accurate way to measure it is to run a "crit line". Many centers aren't set up to run it and some insurance companies won't pay for the extra expense. A typical dialysis diet has about 100 g. protein and 2000-2500 calories which can cause weight gain, especially if you aren't real active.

I realize that I'm considered an outlaw patient but I don't see the connection between dehydration and dry weight.

[monrein]

I realize that I'm considered an outlaw patient but I don't see the connection between dehydration and dry weight.

Well isn't dehydration just dry weight taken too low?  Meaning that too much fluid has been pulled off and the body is then dehydrated.  Dehydration also lowers blood pressure and can cause clotting of a fistula.

[flip]

Exactly. When they had my dry weight too low, my BP would nosedive as soon as I was hooked up. Now I've raised it by four kilos and have no problems.