Amount of liquid in end-stage renal failure?

[Zach]

For those with no kidney function left, some centers may determine the daily fluid intake (gain) by using the dry-weight of the person and how many hours per treatment on the hemodialysis machine.

This is one formula that may be used:  10 ml per kilogram of body weight per hour.
It is about how much fluid can be removed by hemodialysis per hour without causing major side effects.

So if you weigh 60 kg, that's 600ml per hour you can remove.  If your're on only 2 hours per treatment, that's a total of 1.2 kg you can gain.  If you're on four hours, your total fluid gain can be 2.4 kg.

There is a more conservative formula that regardless of body size, one should not remove more than about 400 ml per hour because that is about the same rate at which fluid shifts from the tissues to the bloodstream.
http://www.nocturnaldialysis.org/lowbp.htm

[kristina]

Thanks Zach for making it so very clear.
I  shall bear this in mind because it will help me
when the time comes. Thanks again!
Kristina.

[Hanify]

Also Kristina, I am on PD which is much kinder re the fluid.  When I was on haemo I had to be much more careful.  On PD, although you still have a restriction, it's not such a big deal if you go over - you can just re-jig the dialysis you do and take a bit more fluid off over the day.

[kristina]

Thanks again, Hanify.
I am very grateful that this point is kindly
explained by several people because
the turmoil which goes on in the mind
during the pre-dialysis stage, when one is
panicky, frightened and fears the future
seems to prevent one from thinking cool
and logically, and so the comments given
are very helpful and bring back a structure
to a mind that is disturbed
by the prospects ahead.
Thanks again.

[Hanify]

Do you know if you're going to do haemo or PD?  I have done both, but never home haemo.  Don't be too scared - it's kind of one of those things that, once you start you do get used to.  After a while you can't imagine what you did with all your time before.  It does become part of your day, and is definitely better than feeling sick!

[RichardMEL]

Zach - thanks - that's interesting reading. Because I run a profile I commonly take off 800-900ml in a half an hour block at the start of a treatment (UFR of 1500-1800) under profile six. I do this because say I have to take off 2.4l over a 5 hour treatment (as was today's setting) I get the majority of it off in the first 3 or so hours. My body seems to tollerate the higher UF pull earlier on and I have no problems. We did a refill study the other week and you could see it graphed on the machine and in the "breaks" (when the UFR resets to 100 for 30 mins) I often would refill to 90% which was just fine.

I ound when I did not use a profile and would run at say 480 UFR for the whole treatment by the last hour I would often start to crash or cramp and it was really bothering me. Using the profile has really helped me in that regard - but I know it's not for everyone. Half the nurses in my unit don't believe in it, but I've been doing it for 18 months now and I think even most of them are convinced that for me at least it works.. so they don't give me grief anymore when I want it set (though these days they mostly let me set it myself ).

Kristina, the fluid limits are set with two goals in mind (I am now talking about hemo dialysis):

1. Carrying too much fluid is bad for the heart and lungs and can in extreme cases of fluid overload cause breathing problems, heart problems and other severe problems.

2. As Zach suggested, there's a "healthy" amount of fluid dialysis can remove per hour. Because Dialysis sessions are limited to say a max of 5 hours in center (obviously home patients can do runs of that means the total amount of fluid you can safely pull out of a person is going to be less. I know in my unit they WILL NOT take more than 5L off in any one treatment (so that will be 1000ml/hour for 5 hours). I have seen patients come in 7 or 8kg over. They told me of one person once that came in 10kg fluid overloaded (!) scary. More likely than not patients having to take that much off will suffer from pulling so much and cramp or "crash" (low BP, feel faiint, etc.. it is not fun) and of course if you only take off say 5L and someone is 7kg over, then they will leave still carrying 2 litres extra fluid.. and that's not good either.

I was always educated that the "normal" or "ideal" (stupid terms, I think) fluid gain between in-center treatments should be no more than 2kg. With treatments every other day that works out to around 1L(kg of fluid) per day. I can usually keep it to around there though weekends with the extra day are much harder, and requires some will power. Everyone is different though. I find the most I can tolerate being removed in a session is around 3.2-3.5 litres. The most I've ever taken off was 4.1. Some guys in my unit usually always come in 3.5 or so over and they are OK so everyone's experience differs.

I know this is a confusing topic!!! I do think it is something that is important to manage correctly. I'd rather go without now and keep my body in an "OK" state for the hopefully future time when I can down 3 large iced coffees in a row (and then probably puke!!  )

[kristina]

Thanks Richard and Hanify for this valuable information.
I haven't yet decided which type of Dialysis to go for.
But let me thank you for this valuable information about the
"fluid-business", it seems a little confusing at the moment,
but no doubt this information will be valuable
when I come to the Dialysis itself and I really appreciate all the replies.
At the moment it seems all rather frightening
but having all this information to refer to
is extremely important to me
as, I am sure, 
it is for other pre-Dialysis patients
who read this.
Thanks again!

[Hanify]

Well, speaking for myself (which is all any of us can do) I find PD with a cycler machine at night extremely easy.  I mean it.  It took a while to get used to being attached to a machine at night, but the dialysis itself is easy.  It means I do one 'exchange' during the day (not for long though), and I could do that anywahere.  If I wanted to go out after school with my mates I'd take it with me, and do it in a toilet, or my car.  It only takes about 40mins, then you're away.  I've travelled with my machine to the US and Australia, and am planning to go to Samoa in August.  There's issues with your body image - the tube, and the fluid etc, but I much prefer that to doing haemo in centre.

[kristina]

Thank you, Hanify to let me know,
I shall look into that!

[celtic warrior]

My Wife Maria chose H.D. in centre. She has been on Dialysis for just over 2 years now.
The original decision was made between the two of us, (because Dialysis affects me as well as her).

The major deciding factor was this-:
IF (god forbid) anything went wrong , then there would be qualified staff on hand to deal with it.

Secondly to that,Maria decided that it was much easier to hide a fistula than a tube, plus at the time there was a major
outbreak of Peritonitis,which, after all she had been through, wasn`t appealing. On top of that, Maria has Goodpastures Syndrome,
a NASTY disease, which basicaly means that your own body is attacking itself (Kidneys and Lungs). Anyway, I digress, the choise?
is yours . P.D. is good for some but not for others and vice versa. You must weigh up the pros and cons of all methods of Dialysis, and hopefully you will find the one you are happy with. Whatever you choose, may it give you a long and active life,

Tony

[kristina]

You are very kind, Celtic Warrior.
Thanks for you advise and good wishes.
All the best to you both!

[RichardMEL]

Hanify I would love to do PD/cycler and/or home hemo.. but I love alone and I don't have manual dexterity(spelling?) to handle the needles or the PD stuff - I discussed it with the PD nurse prior to dialysis and we agreed that it wouldn't be a good idea given how easy it is to screw it up and cause an infection or something... so sort of like CW's wife I like in center the staff are awesome (and it is quite social too in a funny way) and I know if anything bad happens they will take good care of me.

I realise doing PD and/or home hemo would be much easier on me with the fluid restrictions and all that, but it's not a realistic option for me. That's OK I am fairly happy with where I am at.

[kristina]

Thank you for replying and I wish you all the best. I have talked it over with my husband and he feels the same that it would be safer if I would be in a centre. I also feel from the answers that it might be a character thing as well, that some people handle the "do it yourself home-dialysis" and others find it unapproachable.  At the moment I feel home-dialysis is not for me. Thanks again for your kind answers.

[Hanify]

The most important thing is that you are making the decision that suits you.  It looks like you are too.  Once you're an old hat at dialysis it's always possible to change at a later date.  Good luck with it all.

[kristina]

Thanks again! Mind you, my husband and I
are still studying all aspects of Dialysis and
it is great to be able to ask questions here.
That really helps a lot!

[Hanify]

Feel free to pm me or send an email if you want to ask any more detailed questions about PD.  We're all here to help in the only way we really can - with our advice.

[kristina]

Thanks Hanify for the kind offer.
Please feel free to send me an e-mail if
I can assist you with anything.
I do hope your treatment is going alright.
Best wishes from Kristina.

[aharris2]

At the risk of being way off-base because cats are cats and people are people, I will share Harry's story. Harry is my cat and his kidneys are failing. As this has progressed, he pees more and more in his body's attempt to wash out the toxins. I now see him drink frequently from his waterbowl, something I never saw before.

In his body's attempt to remove the toxins, he runs the risk of dehydration and even electrolyte loss.  The vet has put him on subcutaneous fluids every other day to help compensate for the lost fluids and electrolytes  (apparently a point is reached where the animal cannot drink enough to make up for the loss).

Do humans go through the same process (the body trying to wash out the toxins?) and might this be why a predialysis STILL PEEING kidney patient would be encouraged to drink a lot?

[RichardMEL]

I feel very sad for Harry just reading that - how horrible.

I don't know that humans are like that although yes I do recall being told to drink water to flush the kidneys as much as possible prior to starting dialysis - but I was also told to keep a watch on my ankles and other areas to look out for fluid retention and obviously if that happened to stop drinking and do something about it. Luckily that never happened to me.

[Restorer]

That's how my kidney failure progressed. After being diagnosed, I was predialysis for almost a year and a half, and that entire time I was peeing enough to keep my dehydrated. I'd wake up thirsty and have to drink a ton of water. My kidneys finally started giving out this year, as far as fluid excretion goes. Now I finally have to rely on PD ultrafiltration each night.

[kristina]

As far as my liquid-intake is concerned, I have tailored it to my requirements.
Maybe, other people would drink less, or more, than myself.
So, again, like diet, liquid intake is perhaps tailored to the individual and their needs.
Kind regards from Kristina.