Dry Weight Vs Residual Kidney Function

[Charlie B53]

I'm still pretty new at this Hemo stuff having been on PD for 3 1/2 years before my infection that caused me to lose my PD cath and start Hemo in December.  But already I have noticed huge differences in how I feel depending on my 'Dry Weight'.  My first two months on Hemo they kept lowering my weight in attempt to determine my correct 'Dry Weight'. When we got down to 104 K I was so tired after every session I would get home and sleep for hours, and still feel exhausted for most of the next day. I kept having leg cramps while sleeping, terrible pain that forced me to get up and walk until the muscles released the spasms.  The Clinic kept trying to get my weight even lower, dropping me to 103. I began cramping during treatments.  It was Hell. I managed to convince them I was too 'dry' and we began raising my dry weight.  Finally now I am up to 106 with NO cramps, and the exhaustion is mostly gone.  I can stay up most days after treatment and feel almost like a normal person.  Not physically able like before but not bad considering.

Kidney function.  I have always had some residual kidney function.  I think that less than a liter I produce a day to be very helpful in keeping my labs as well as they are. On PD my numbers were very good, Hemo not so well but still well within acceptable levels.  I still take massive amounts of water pills, recently stopping those only on dialysis days at the direction of staff.  While my dry weight was so low I didn't make much urine, almost none following dialysis, slowly increasing as my weight rose making more on Sundays and Monday mornings shortly before treatments.  Now at 106 I am still making urine even on dialysis days AFTER treatments!  Without water pills!  I do take one dose of water pills once I get home after treatment but I have noticed that I P just before treatment than again immediately after treatment.  Not a lot, but most of a cup.  I do see a very small amount of swelling just at and above my ankles.  No where near enough to cause any leaks, just enough to know I do still have some swelling, not a problem.  But keeping my
Dry Weight' at this level I feel does help maintain my residual kidney function which I believe is critical in helping not only my labs but my health.

I guess what I am getting at is we may NOT all have to totally lose Residual Kidney function so soon while on Hemo depending on how we determine our 'Dry Weight'.  Lowest isn't always Best.

Something else I often wonder about.  How much I can allow myself to drink. I am pretty tough on myself.  I use mint Lifesavers and/or ice cubes when I feel I just HAVE to have a drink most of the time.  Granted there are times that I do give in and tilt the milk jug and chug a few mouthfuls, noot very often, only once or twice a week, if that.  And almost every other day I will fill my glass of ice with water.  Cheating, or so I tell myself I am cheating.  But when I weigh in at clinic I surprise myself, staying most days UNDER 2 K's.  So I have to ask, am I doing Good, Fair, Poor with my gains?  I have NEVER, yet been 3 over, but I have had a 2.5  I have noticed the larger the take off the more 'tired' I am after the session.   I asked the Dr if it is possible that the take off is dehydrating, thickening the circulating blood, just a small amount and that is causing my heart to work harder.  The increased work load thus causing me to feel like I have done a LOT of physical activity making me tired.  This lasts for almost a whole day, as long as it takes for my body to 'reconstitute' for the circulating volume to reclaim water either from my diet or reabsorb excess water from the flesh, thinning the circulating blood and thus becoming more 'fluid' and easier for my heart to pump it.   Dr said "N'ah."   I think differently, it just makes sense.






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[Michael Murphy]

Charlie I was told the real rule is not 32 Oz of fluid but 32 oz of fluid above your output.  I personally think the dehydration caused by lack of fluid and over eager techs are the reason so many people loose RKF.  however periodically  let them challenge my dry weight but I stop them when eithe my BP drops or I start cramping.  That's my new dry weight.  The other reason my dry weight is lowered is since I am slowly loosing weight is occasionally I arrive below my dry weight, the second time this happens my dry weight is lowered about a kilo and a half.  This system seems to work since I have been on hemo 4 years and I still am not fluid restricted.  Right after my last heart attack my output dropped drastically and I was fluid restricted until my ejection fraction went up and so did my fluid output.






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[PrimeTimer]

My husband has dialysis 3x a week, 4 hour treatments. They usually only have to remove 2 or less kilos of fluid from him. They are happy with this. This amount includes the saline they use for "rinseback" at the end of each treatment. The less they have to remove from him, the better he feels afterwards. He's been good at controlling his fluid intake. He use to never really sweat in the summer but ever since he started dialysis (3+ years ago) he sweats a little now when it's hot outside. On those days he drinks a little more or sucks on a few more ice cubes. He has almost no residual function left anymore.

[Riki]

I lost residual function after 3 years on dialysis, while I was still on PD, so you can lose it just as fast on PD as on HD.  My dry weight is regulated by my doctor, not the nurses.  They are only allowed to go below my official dry by .5kg.  They've recently started taking an extra .5kg for the rinse back and drink, so I need to start coming in a little lighter so they don't pull too much.  I also need to lose another 5kg to get back on the list, so I'd love to see that dry weight go down, I just don't want my bp to go down with it.

[Michael Murphy]

When I went back to dialysis the first 4 times in center I had 4 kilos removed.  The third time brought me down to my dry weight, I started to cramp and my BP began to drop so I was at my dryy weight.  The nex time I was in I told  the tech to go to my dry  weight. Well she decided to challenge my dry weight which had just been done.  The Nurse Practictioner went ballistic when she saw what was being done, she explained that removing so much fluid could cause a heart attack which would almost certainly be fatal considering the horrible shape my heart was in.    No one has gone below  my dry weight since. That was the maddest I have seen the NP until she found out  I was snow blowing my driveway.