Dry Weight?

[Charlie B53]

I haven't been on Hemo for very long.  I have a whole lot to learn.

We are not sure yet what my 'dry weight' is yet.  We have dropped my weight a considerable amount below what I have been the last few years on PD.  I am not so sure that this is such a good thing.

Reading that post of the Study on Cardiac Shock, Blood Pressure Drops, the loss of Residual Kidney Function, all have me thinking very had about blood viscosity, fluid dynamics, the possible effect on the body systems, heart, kidneys, and lings, of the effect of blood thickening, dehyrading the circulating blood during Dialysis.

How do we determine how much water is 'excess'?

What is the allowable amount to remove fro the circulating system before damage occurs?

What damage occurs first?  Blood Pressure drop?  Or the loss of Residual Kidney function?

I suspect blood viscosity can be easily determined by very simply centrifuge testing.  The Red Cross regularly spins blood down to seperate the parts.  It shold be very easy to see the liquid component before and after a Dialysis treatment. 

Losing too much circulating liquid causing thickening in the blood I develop cramps in the top side of my calves.  Later in the day/night I develope cramps in my thighs during sleep.  I have to suspect blood thickening to be the cause of these cramps, the blood is simply too thick to adequately flow through my clogged arteries.

Is this also causing further damage to my Kidneys?  Causing me to soon lose what little Residual Kidney function I still have?

Tomorrow, Friday, I am told the Dr I have  not met yet, will be making rounds.   I am going to print this, double spaced, to make room for comments.  And give him a copy.

When, or IF he responds I will post it.

Take Care All,

Charlie B53

[Michael Murphy]

Dry weight is the 25 pound monkey on every hemo patient.  Excess fluid retention is not a good thing nor is excess water removal.  First thing I learned was to wear the same kind of cloths, if you wear heavier cloths it will look like water gain not good, failure to have your usual solid waste removal activities not good that can add several kilos, this is made worse because excess fluid removal can't cause that waste stream to come to a halt.  Unfortunately the only. Reliable method seems to be pull fluid till your BP drops.  This whole mess becomes more difficult if you are losing weight. Weight loss is common on hemo the process also pulls off protein, this is why the albumen levels are so important.  Why we are encouraged to eat more protein.  Patients have the power to limit fluid removal, use it wisely but if you haven't had you usual sit down in the library ( see waste removal comment above) in several days that is the time to object to large fluid removal.  Plus remember the rule for fluids is one liter over your personal fluid removal.  So if your out put is half a liter a day then your input is limited to a liter and a half.  Listen to your body I am under going large fluid removals because of my heart attack, however I start to have finger cramps before I have large muscle cramps.  That's when I have the fluid removal stopped,  (as a aside my cardiologist had a fit when he learned about the fluid removal and put a floor on what could be removed a tech didn't listen and exceeded the limit, the nurse practioner for my nephrologist chewed a new body exit on the tech, it was a site to see, no one goes below the limit now). However the bottom line is dry weight is not science it's a art, the most accurate gauge is how your body is reacting, monitor how you feel and do not be afraid to tell the techs and nurses when you think that enough is enough.  Good Luck.

[Charlie B53]

I have gotten cramps in my calves during treatments.  Not the calf muscle itself but just under the bone as in directly behind the shin.  It was a new experience.  I've had all types of cramps, most always from over exertion.  As well as nightly leg cramps, those can be either calf, or thigh.  These cramps during treatment are totally different.  But generally are an indicator of later nighttime legs cramps to come.

I can fix a large mug of chicken broth, that always seems to help.  First thing home from treatment having those calf cramps, that cup of broth, measures two actually, and I won't have the leg cramps that night.

Jewish Penicillin, I swear there is something to it.

My major worry is the possible damage this may be doing to my Residual Kidney function.  I swear it is a huge help in maintaining my Phosphorus level, and I do not want to lose that just because the Clinic wants to lower my 'Dry Weight'.

[Michael Murphy]

The reason the soup helps is two fold the salt helps and it replaces fluid, the biggest factor is salt.  Other thing that help are coffe and chocalate because thy contain cafine. My bet is your cramps at night occur after doing hard wok and sweating a lot,, the same things that help in dialysis help these cramps any lose of fluids and salt cause cramps.  Edited to have coffe and chocolate container caffeine instead of salt.

[cattlekid]

I agree 100% with Michael Murphy that dry weight is an art, not a science.  I always had residual kidney function when I was on dialysis, I never stopped peeing.  When I first started dialysis, my dry weight was set about a kilo too low.  I was in center and I would leave after every treatment feeling like a limp rag.  I did a lot of reading here and then got up the nerve to ask the rounding nephrologist (not my personal nephrologist, just a guy in his practice) to get my dry weight changed.  I thought it would be a big argument and when I told him I wanted it upped by one kilo, all he did was say "ok" and changed it.  I felt much better after each treatment then.  I was taking off no more than two liters per treatment.  I always told the nurses that I would rather leave with a half kilo extra on than be cramping and nauseous during treatment.  I think I messed up their statistics but I didn't care. 

Once I went to home hemo and five day a week treatments, things were a lot easier.   There were many days where I only had to take off enough fluid to cover rinseback. 

[Riki]

In the beginning, dry weight seems to be trial and error.. it took a while to figure out where it was best for me.  I don't cramp, I pass out, so it was something they wanted to figure out quickly.  I still have low bp issues.  The machine alarms when the upper number (can't remember if that's systolic or diastolic) goes below 100.  I don't have any symptoms of low bp until it goes below 90.  I had to have the doctor put an order on my chart not to mess with the fluid removal until it goes below 90, unless i have symptoms or ask for them to change it.  After a year, it's still hard to get the nurses to adhere to that.  I have gone home with an extra half litre on simply because my bp was running low and the nurses didn't want to take it off

[Charlie B53]

I gave the Dr a copy of my post and told him I had posted it here.  He didn't say much.  Since it was our first meeting he went over my labs, all good except for pTh at 1000.  Increased the one Vit D from twice a week to daily.

And increaed my dry weight from 103 to 104.  Not much discussion about cramping, residual kidney function loss, but I am pretty sure he did understand my concerns and agreed there still has not been enough studys.

I'm happy with my new dry weight, I don't expect any cramping tonight.

[cassandra]

Glad to hear that Charlie. Keep an eye on your Calcium (vit D is probably binded with that, and it's a big increase)

Good luck, Cas

[Charlie B53]

Blood Calcium used to be off the chart.  Historically always at the max 10.2 and very often slightly above. Last year it started climbing, to a new record 11.7 started crystallizing in my joints.  Dr's claimed it to be gout.  I think it was pseudo gout, calcium not uric acid even though my uric acid levels were slightly elevated.
Dr doubled my Sensipar, calcium is now under 9, first time in 30 years or more.  Only on PD since May 2113.  I ain't Normal.