Weight, water, and scales

[jessshar]

I have some general questions. My dads dry weight is at at 85kg. We have been doing a pretty good job at keeping his weight gain between treatments at 2-3 kg. But because of his lack of appetite I think he may be losing weight. How can you tell? One of the techs at the center said they don't usually ever readjust his dry weight. He still has some urine output about 300-400 ml on a good day. And they donut have him on any fluid restrictions. I restrict his fluids ( learned that from this site  ) so I can keep his gains down between treatments. Does anyone use a scale at home? Can I use a scale everyday to adjust how much he drinks? Does Nepro count as fluid? And soup? And what about the liquid that is contained in food itself?

I know some of these questions may seem a little dense  Thanks for all your help!!!!

[jbeany]

In theory, your center has a dietitian who has all this info - but that's only a theory!

Yes, it's good to use a scale every day.  Weigh when your dad gets home from D, and then you can see how much he is putting on.  Lots of digital scales let you have the option of results in kgs, to make things even easier.

The only practical way to tell if he is losing real weight and not water weight only is to watch for symptoms of excess fluid - how swollen are his ankles and fingers at the end of each run?  If he still has fluid on him, then the dry weight needs to be adjusted.  It's easiest to "challenge" the dry weight in small amounts.  Instead of 85, have them set the goal to 84.7 or 84.8.  If he reaches that without any signs of bp crashes or cramps, and still has puffy fingers at the end, keep challenging the dry weight a little more each run.  Some centers will fuss and fight, but it's your dad's right as a patient to set his own fluid levels.  He knows his body better than anyone else, and if he feels like he is retaining fluid, then he needs to speak up and demand that they try to take more off.  Don't let them make huge adjustments, though.  .2 or .3 at a time is good - work down slowly.  Have him see how he feels at the end of each run - if he's getting cramps or headaches after the session, even if he didn't cramp or crash during it, then he's too dry.
Don't wait for the techs to decide he's overloaded - if the ones at your center have already said they never adjust dry weight, then they are unlikely to do anything until he's so overloaded he's having trouble breathing.

As for food, any food with fluid in it counts toward his total fluid intake.  Ice cream, jello, soup, watermelon - all these sorts of things add up. He can still have them, he just needs to adjust how much he's drinking accordingly.

[Rerun]

Yes Nepro is fluid and so is soup and water on salad or anything that was made from liquid like Jello.  You also lose some fluid from breathing and sweating if you exercise or sit in a hot car.  Dry weight is a moving target and we don't ever get it exact.  What you want to do is keep extra fluid off. 

If ankles start to swell or any other part of the body, that is an indication of extra fluid.  My left boob is my water retainer.  Nice hua?  Then you may want to "challenge" his dry weight.  To do this ask them to take 200 to 300 cc's more off then his usual dry weight.  So instead of trying to get down to 85kg go down to 84.7 or even 84.5.  If he does well.... doesn't cramp or lose Blood Pressure then he has extra fluid on.  Challenge more the next time until he does have a "crash".  Not fun, but necessary if you think too much fluid is on.  Too much fluid is not good for the heart.

Hope this helps.         

[RichardMEL]

You know what makes me so angry about this is the tech saying they don't adjust dry weights in the unit. WHAT THE..? Either that's just lazy or plain incompitent, but either way that's a seriously bad idea in my book.

As you say your dad has little appetitite, so absolutely that suggests that any weight he may be "keeping on" (ie: staying around the 85kg) is going to be fluid. Now it is true that some patients don't NEED fluid restrictions while on dialysis, but that's fairly rare in my experiene, and it is a good idea to not go overboard anyway - specially during dialysis "weekends" when you have an extra day between treatments.

You can ask the unit to do a crit line, or BVM (Blood Volume Monitor) on your dad if they have the machines capable of doing that - that will give an idea of how dry or wet he is based on the "refill" rate he is getting. Another method is these special scales that some units have (mine does) that somehow measure the percentage of water in your body, and from that you can figure out if you're carrying a bit much or not.

As the others have point out the really important thing is to look for signs of fluid overload - swollen fingers, toes, ankles etc, and if he ever has trouble breathing you MUST do something about it as that could indicate fluid build up around the lungs. Also a higher blood pressure can sometimes indicate too much fluid(as in the heart working harder to push all that fluid around).

re Scales - absolutely!! I keep a set at home and weigh myself all the time (I feel like a model or something!  ). One thing to remember is that home scales will almost always be far less accurate than the ones used for dialysis, and you need to figure out by what factor. What I do is I weigh myself when I leave dialysis, go straight home, and weigh myself at home - same clothes, without eating or drinking anything. I theen take the difference between the two and call that the "error" amount. For example my home scale is 0.4 higher than the D scales, so I adjust accordingly, and weigh my changes say the next morning, next evening after work etc and that gives a fair guide to how much I have put on. I keep myself to 1.5-2kg between treatments using this process and that seems to work well for me.

It sounds like you're trying to be very sensible and watch what your dad is doing which is really good. It seems poor to me that the center doesn't seem to be doing much to help when it's partly their job, I would have thought.

[Bajanne]

"Not adjust dry weight"  How nonsensical is that!
My dry weight goes up and down as I gain or lose weight.  The only stipulation here is that the nephrologist make any big changes, but the nurses can lower or raise 0.5 kg as necessary.

[aharris2]

jessshar,

Good for you and your dad in being so proactive in his care.

As the others have said, if you think your Dad is losing real weight due to a poor appetite, "challenge" his dry weight by a little each treatment. When we are in challenge mode, we usually do it 0.5 kg at a time, but my brother has been on dialysis for a long time and weighs a bit more than your dad.

When you/dad walk in, tell them what weight you/dad would like to leave at. If they question you, let them know you are "challenging" and why. I see in your profile that you are in Las Vegas. We have dialyzed at DaVita South Las Vegas as a visitor and had no problem in setting our own goal. What unit do you use?

[jessshar]

We use Frensious on South Pecos. They never have had a problem with letting me challenge his dry weight. But now they are telling me that even though he really doesn't eat that he could be gaining weight. I talked with the Doctor today and he said even with no exercise or food and just Nepros he would have too have a calorie intake of at least 2400 cal. to gain weight! His actual intake is maybe 1700-1900 calories max a day! His Bp when he start a session is around 100/60 but slowly starts to decline. Sometimes I think they have no idea of what they are talking about.......................

[Rerun]

We use Frensious on South Pecos. They never have had a problem with letting me challenge his dry weight. But now they are telling me that even though he really doesn't eat that he could be gaining weight. I talked with the Doctor today and he said even with no exercise or food and just Nepros he would have too have a calorie intake of at least 2400 cal. to gain weight! His actual intake is maybe 1700-1900 calories max a day! His Bp when he start a session is around 100/60 but slowly starts to decline. Sometimes I think they have no idea of what they are talking about.......................

Agreed!

[aharris2]

The techs and nurses tend to be very set in their ways. They see a low bp and take it as a sign that his weight/fluid is about where it should be, if no too low. Low blood pressure is a problem during dialysis. At our unit they won't let you leave until the first number is at least 100.

That said, there are other causes of low blood pressure. It sounds like you've been able to get the doctor's involvement. Have your dad's bp meds reviewed. Perhaps his needs have changed and they need to be reduced.