What is acceptable gain?

[Bajanne]

I  am new to this dialysis thing.  Last session they took off 3 kilos.  I asked the nurse if that gain was too much.  She said not really.  What is acceptable gain and what is unacceptable.
Also, my dry weight has been changed since I started at the end of Sept.  It keeps going down a bit.  But I know that I am losing weight because I don't eat as  much.  However my cholesterol is still a big problem.
I will start a post dealing with that if I don't see one.

[susie q]

Hi there,    My weight gains are usually close to 4 kg..   I think a lot depends on whether you have urine output.. I have none so I have to be careful... getting the hang of it now.. lol

[LifeOnHold]

How much you can safely gain between treatments depends on your weight, activity level and lung health-- the 4 kilos that I can gain might make someone else go into respiratory distress.


Are you short of breath between treatments?  That's a big sign that you're putting on too much fluid.  Also, if you are cramping at every treatment that also means you are gaining too much fluid.   Your body will give you little signs when the amount is getting to be too much-- treatments will be a lot harder and your BP will be unstable.  Note when you have an easy treatment, and try to keep your fluid intake at that level for next time.

Learn as you go... it's all you can do!   

[Rerun]

My dry weight keeps changing.  I keep gaining dry weight (as opposed to fluid weight) so it is hard to tell.  Sometimes I lie about my weight gain.  If it is 55.9 I'll just say 55.5.  My appetite is too good and I'm gaining weight.  But, they keep trying to take it off in fluid.  You can't squeeze blood out of a dry turnip. 

[LifeOnHold]

Don't lie about fluid gain-- the techs and nurses have to know how much you weigh, because they program that into the machine.  If you say you weigh 55.5 and you really weigh 55.9, that's .4 over your dry weight, and when you come in for your next treatment, it'll be whatever you gained at home plus the .4 you left with.  Over time, that could mean that you'll have real trouble getting down to your goal because you're always leaving 'heavy.'

If you believe you are gaining actual body weight as opposed to fluid weight, talk to your doctor and ask that your dry weight be raised.  You can be run on a crit-line to determine what your actual fluid load is, and they will be able to see how much weight they can try to remove before your blood pressure goes down... that's a better way to set a new dry weight than trial-and-error.

[Rerun]

What is a "crit-line"?? 

The thing is... I don't see the doc that often and the techs won't let me change my dry weight by myself. 

[LifeOnHold]

A crit-line is either a free-standing machine or a program in the dialysis machine that can calculate how much fluid can be removed from your blood by watching your blood pressure and pulse as you go through your treatment-- limits can be set so the machine alarms when your pressure starts to go down, and they can back off the fluid removal for a while.  When your pressure goes back up, they can again try to remove more fluid. 

When they've put me on a crit-line, I usually am able to remove at least a half-kilo more than I normally would.

Doesn't your doctor make rounds during your treatment?  They do here-- by law they have to at least a few times a month.  Our doctors are usually rounding on Tuesday and Thursday.

If your doctors don't do that, you could tell the charge nurse that you would like her to ask the doctor to change your dry weight... you'll have to be a pain about it, if you have the kind of unit where they think only the doctors and nurses know anything about dialysis.  Once they realize that you understand your treatments, they'll be more likely to work with you.

[Rerun]

Okay, I'll ask about it.  Yes, she (Dr.) does come around, but I have to remember to tell her I want my dry weight changed. I'm usually bitching about something else like how friggin COLD it is or how incompetent everyone is. 

[LifeOnHold]

It's friggin' cold in my unit, too.

Occasionally I bring one of those back-pain warming patches in for my treatment, and put it on my stomach.  It works well, but they're a little too expensive to bring them in for every treatment.

[Bajanne]

Well, it seems we just can't be pleased.  I keep asking them to please turn the AC a few degrees lower!  I like to feel cold.  They said that the hospital techs say it should be at 72º and that is where it is supposed to be. but I don't feel comfortable.  Maybe their thermostat isn't working and it is really hotter than that.
At what temperature does your unit operate, guys?

[Rerun]

-40 below!   

LOH - They don't have crit-lilne capabilities.  They did know what it was though  Surprise!  Surprise!

[Jamie]

Dear fellow renal readers,

  In my unit in the hospital they don't really give a shit if I'm cold or hot or even sweating. As long as they get those dialysis needles in and I don't die during the treatment they consider there job done.

   Unless they are too cold or too hot them selves then and only then this is a different matter it may be our life on the line we may or may not die but this is there job's were they can call in sick or take a day off or get Christmas off with pay or take two weeks off or even quite.

  But for us there are no breakes no holliadays no choices and no freedoms if we were to try and take a break there is only one thing and you's know what I'm talking about.........Jamie-G

[kitkatz]

The 99 cent store has heat packs for 99 cents. MMM Warm.

[GuyIncognito]

I have been informed that the max weight gain is 4Kg anyting higher than that and you'll get the business, however it really depends on where you do dialysis.
I'm now at a Bayshore clinic and as it is outside the hospital you are allowed to get away with a little more, fortunately my output even after 4 years is almost 100%

[Zach]

I read a study a while back (sorry, no link) that saw a positive correlation between higher fluid gain and better nutritional level of the patient.  It's somewhat controversial ... you don't want average size people gaining 6 or 7 kg in between dialysis treatments.

I still think an arbitrary limit without considering the patient's size, activity level, etc, is not the best policy.

The problem as mentioned earlier in this Post is its effects on the heart.
But if you exercise often, perhaps that helps keep the heart in "good" shape, even if you gain more than what is acceptable.     

[Zach]

Well, it seems we just can't be pleased.  I keep asking them to please turn the AC a few degrees lower!  I like to feel cold.  They said that the hospital techs say it should be at 72º and that is where it is supposed to be. but I don't feel comfortable.  Maybe their thermostat isn't working and it is really hotter than that.
At what temperature does your unit operate, guys?

Did you know that most of the dialysis machines has a variable temperature control
If I feel too warm, I have it at 36.0 or lower.  If I'm cold, I have it at 37.0.  Normally it's at 36.5.

Also, if you suffer from low blood pressure during dialysis, lowing the temperature may help a bit.

[BigSky]

Our unit got rid of the old standard of all people only having 1/2 to 1 liter a day.  They use a percentage of dry weight.  3% during weekday treatments and 5% over a weekend.

The old way never made any sense in how a 100 lb person and a 200 lb person should only consume the same amount of fluid in a given day.

[angieskidney]

Our unit got rid of the old standard of all people only having 1/2 to 1 liter a day.  They use a percentage of dry weight.  3% during weekday treatments and 5% over a weekend.

The old way never made any sense in how a 100 lb person and a 200 lb person should only consume the same amount of fluid in a given day.

That is different. How does the percentage system actually work? In my unit they just use the old system. I usually gain 4- 4.5kg over the weekend and during the week I usually gain 2-3kg.

[sandman]

Okay, let me see if I got this right.

Your last known dry weight is divided by your calculated fluid weight accumulation.  The result equals your persentage.  Is this correct?

[BigSky]

That is different. How does the percentage system actually work? In my unit they just use the old system. I usually gain 4- 4.5kg over the weekend and during the week I usually gain 2-3kg.

Example would be if you had a dry weight of 50 kilos.  Your acceptable weight gain by fluid would be 1.5 kilos (3%)during the weeks treatment.  Such as M, W, F.  Over the weekend F-M it would be 5% or 2.5 kilos. 


The effects of fluid on a 50 kilo person and a 100 kilo person are completely different.  Whereas taking off 5 kilos on a 50 kilo person is 10% if body mass and taking off 5 kilos on a 100 kilo person is only 5% of body mass.

[angieskidney]

How come more units are not going with this method? I know one guy in my unit .. he must be like 220lbs and he goes by the same as I do and I am about 140lbs I think (62.5kg). Now wonder why his BP always drops and he always has cramps.

(By the way, I can't figure out the math ... I am just not good at it and am dyslexic to boot. I need an exact math equation to figure out how   . If Jeff thinks he got it I will just have to have him explain it to me..)


edit: Sorry I put my weight wrong.

[Zach]

How come more units are not going with this method?

Some staffers have a problem just figuring our weight gain.     

And it doesn't go with the mantra, "Why did you gain so much?"     

[BigSky]

How come more units are not going with this method? I know one guy in my unit .. he must be like 220lbs and he goes by the same as I do and I am about 140lbs I think (52.5kg). Now wonder why his BP always drops and he always has cramps.

(By the way, I can't figure out the math ... I am just not good at it and am dyslexic to boot. I need an exact math equation to figure out how   . If Jeff thinks he got it I will just have to have him explain it to me..)

Fluid gain by the method would be.

52.5 x 3% = 1.6 kilos during the week treatments.
52.5 x 5% = 2.6 kilos over a weekend.

The guy in your unit sounds like it is true weight gain, not fluid gain.

[angieskidney]

How come more units are not going with this method? I know one guy in my unit .. he must be like 220lbs and he goes by the same as I do and I am about 140lbs I think (52.5kg). Now wonder why his BP always drops and he always has cramps.

(By the way, I can't figure out the math ... I am just not good at it and am dyslexic to boot. I need an exact math equation to figure out how   . If Jeff thinks he got it I will just have to have him explain it to me..)

Fluid gain by the method would be.

52.5 x 3% = 1.6 kilos during the week treatments.
52.5 x 5% = 2.6 kilos over a weekend.

The guy in your unit sounds like it is true weight gain, not fluid gain.

Thanks .. and ya .. I know he is that heavy because of true weight. I was just stating how they tell both of us to limit ourselves the same amount. And I think he said he still pees.

[sandman]

Okay, from what I can make of this.  Your dry weight times 3% or 5% will give you a rough idea of what acceptable weight gain for your weight should be, correct?  So for example... someone weighing 62.5k, there acceptable weight gain at 5% would be 3.1k.

Okay, I can see where this would be practical to dictate what a person of a specified weight is acceptable to consume but where would this be practical when the patient has had more or less fluid gain then what the percentages dictate?  Can someone help me out here?  I'm lost.