What is acceptable gain?

[Rusty]

After you get settled in at a stable dry weight, you may be able to tell by how much edema you accumulate.  If I start seeing the first signs of swelling, I know I've hit my limit.  I try not to do that, but sometimes I see it in my ankles and fingers by Sunday night (I run MWF).  I weigh a few times a day, and go in with 2-2.5k on regular days, and 3k on weekends.  3.5k in the winter.  I hate winter when I can't sweat it off.

How sensitive you are to cold can be related to your hemoglobin.  Those people in shorts and t-shirts probably have hgb of 13 or better.

[BigSky]

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.

There is no relation to what you are asking. 

The idea is to stay under the fluid allowance goals to help limit any potential damage that may be done by fluid overload and to help keep patients from crashing from having too much fluid to remove in the limited amount of time on the machine.

[angieskidney]

Ya, Sandman is still learning as he doesn't understand and it is hard for me to explain what I am still learning. The less you drink the better because only so much can be taken off safely. You don't want to be too dry though after dialysis (especially diabetics) but having fluid overload is very dangerous as it can cause fluid to be in your lungs and around your heart.

I had Pneumonia twice last year. It is not a good thing to have too much fluid on you.

But dry weight can be hard to calculate .. but once you know where you stand .. it is easier to calculate how much your fluid allowance is.

[BigSky]

Ya, Sandman is still learning as he doesn't understand and it is hard for me to explain what I am still learning. The less you drink the better because only so much can be taken off safely. You don't want to be too dry though after dialysis (especially diabetics) but having fluid overload is very dangerous as it can cause fluid to be in your lungs and around your heart.

I had Pneumonia twice last year. It is not a good thing to have too much fluid on you.

But dry weight can be hard to calculate .. but once you know where you stand .. it is easier to calculate how much your fluid allowance is.

If you have problems with finding the right dry weight they should be monitoring you with a crit-line or similar machine.

Personally I pretty much change my dry weight from treatment to treatment.  I always determine what is right from how I felt at my last treatment.  Doctors are suppose to be the ones to change it but its easy enough to get it changed to what I want and just tell the doc to change it when they come around.  They usually come around 2 of the 3 days I am on the machine.

[SpeedFleX]

I think that the lower weight u gain the better. Except when u go minus that isn't good either. I gain about 1 - 2 kilos sometimes when there's  a party then 3.

But I do wonder how some people gain 4, 5 even 8 kilos. You would have to drink at least a gallon and more to gain that which to me isn't be very good about the fluid intake.

my record is 4 kilo through I could breath fine but I still believe that 1 - 2 kilos is enough no matter how much your weight is.

The only time I thinks it's alright to gain more is if your dry weight has to be uped because you maybe ate alot but in between dialysis I doubt u can gain more then 1.5 kilos on fat or whatever

[angieskidney]

Ya, Sandman is still learning as he doesn't understand and it is hard for me to explain what I am still learning. The less you drink the better because only so much can be taken off safely. You don't want to be too dry though after dialysis (especially diabetics) but having fluid overload is very dangerous as it can cause fluid to be in your lungs and around your heart.

I had Pneumonia twice last year. It is not a good thing to have too much fluid on you.

But dry weight can be hard to calculate .. but once you know where you stand .. it is easier to calculate how much your fluid allowance is.

If you have problems with finding the right dry weight they should be monitoring you with a crit-line or similar machine.

Personally I pretty much change my dry weight from treatment to treatment.  I always determine what is right from how I felt at my last treatment.  Doctors are suppose to be the ones to change it but its easy enough to get it changed to what I want and just tell the doc to change it when they come around.  They usually come around 2 of the 3 days I am on the machine.

Heh ...  you are lucky. I see the Neph only once a month ... and the nurses never like me to change the dry weight goal too often .. more than once a week is pushing it in their eyes ..  Seriously!!

[BigSky]

I think that the lower weight u gain the better. Except when u go minus that isn't good either. I gain about 1 - 2 kilos sometimes when there's  a party then 3.

But I do wonder how some people gain 4, 5 even 8 kilos. You would have to drink at least a gallon and more to gain that which to me isn't be very good about the fluid intake.

my record is 4 kilo through I could breath fine but I still believe that 1 - 2 kilos is enough no matter how much your weight is.

That may be your belief but consider this.  Fat, carbs, protein and total calories are based on body size so why wouldn't water.

[Zach]

When the temperature outside is in the 90s, I sometimes leave a little more on me.  Outside in that weather, I sweat a great deal and could lose too much fluid.  Of course I would drink more, too.  Partly for fluid replacement and partly to help my body cool down.

Also, when I go to the beach, I bring a liter of frozen water.  After a few hours, it's empty and I haven't gained any additional weight.     

[Panda_9]

Is there any reason why you sweat so much Zach? That is alot!! I have a hard time with my weight pre Dx as its hard to determine how much of it is food weight and fluid weight, as Im on nocturnal. So you are weighing yourself at the worst time of the day. I am having trouble keeping my gain under 4, sometimes I just loose track of what Im drinking, plus Im thirsty all the time. I do feel it a little bit at 4kgs, I get a little out of breath. The most Ive had on is 7kg and I was having alot of trouble breathing, and had to sleep sitting up. That felt so awful.

And dont forget the effects on the heart from getting too overloaded all the time! I really need to force myself to cut down because I dont want a dodgy heart too 

[Zach]

I think my sweating is a good thing ... as long as you don't mind the smell.     

Sweating a liter sounds about right, when you consider that I'm at the beach for several hours.

[angieskidney]

Wow Amber that is terrible! Fluid overload being bad enough where you have to sleep sitting up! That caught my attention because with my Peritonitis I had to sleep sitting up because it hurt too much to do proper full drains .. man that was not fun!!

Anyway, my dietitian started telling me tricks (that I don't use but thought I would share anyway) to keep my drinks under control. She said I should bring a bottle (liter or what ever is my max/day) and either do one of two things:

• Have the bottle full and any drinks I drink then fill the container with fluid from the bottle. When the bottle is empty I have reached my limit for the day.
• Have the bottle empty and fill it with an equal amount of fluid from any drinks I have had and when the bottle is full then I have reached my limit for the day.

[Panda_9]

I used to do that angie, but I probably wouldnt follow it. I drink out of a 250ml measuring cup for cold drinks, and for hot drinks I know how much all my mugs hold. Most of our glasses are 300ml or more so Ive opted to use something smaller. It was easier to follow when I was living with my parents as for some reason all their glasses are really small, and probably only hold about 200-250ml.

[Bear]

I have a hard time with my weight pre Dx as its hard to determine how much of it is food weight and fluid weight, as Im on nocturnal.

...why don't you weigh yourself before dinner, Amber? I do. Not every night, but then I don't have a big dinner every night, but
 once or twice a week I weigh before dinner, then again before going on the machine (or to bed if it's an 'off' night). It just gives
 me a regular check/idea, how much food weight gain there is. So, if I'm 131 before; have dinner and 2 cups of tea & then I'm 131.8,
 then my 'real' fluid gain between the 2 was only about .4, with the food about .4. I started doing this when I found I was coming
 off regularly below the target. Then I tried to cut down on big dinners (I've never really liked them anyway) esp. on pre-dx nights, as
 they made me feel uncomfortable later when I was on.
 Then I found the under-target days were intermittent and I realised I hadn't accounted for food when weighing. My target is also
 the keyed in target (i.e. I don't add the classic "300 for saline; 300 for drinks" thing), and even if I  have a couple of cups of tea, I
 still usually meet the target. I suspect there may be some magic mixed in with the science tho..   

[Panda_9]

I usually guesstimate what my dinner weighs. I sometimes weigh myself before and after dinner but most of the time I forget. My post weights are sometimes all over the shop, which is probly because of big dinners, which doesnt make me look too good in the fluid department! I count the 300ml washback, but I always take a cup of tea or cold drink with me before bed which I dont count, and most of the time I come off spot on. I try not to eat too much, as whenever I put something in my mouth, my abdomen swells, and swells, and by the end of the day I look pregnant, bit like being on PD really.

[Bajanne]

I have to 'fess up.  I have not been doing too well this last week in restricting my fluids and I have been ending up with as much as 4kg over my dry weight.  I had a severe wake-up call today.  After the weekend, I had 4.2 to take off.  I had quite a nice session, sleeping away until about the last 10 minutes.  I woke and found myself with severe cramps - my left calf and my right foot.  Excruciating pain!!!  All I wanted to do was put my feet down, but the nurse thought that there was the possibility of my keeling over since my BP was low.  It took a while for things to cool down. I was frantic!!!
I am almost glad that school is starting back.  That controls my liquid intake greatly!

[Panda_9]

I think I would definitely drink less if I had more things to do. Alot of it is probly boredom.

[Zach]

I think I would definitely drink less if I had more things to do. Alot of it is probly boredom.

I think you've got that right!!     

[Panda_9]

I spend most of my time at home, so I am always bored. If I could do more things I would forget that Im thirsty or hungry. Im just too tired to do anything.

[angieskidney]

I completely agree! I find that I am bored and sad a lot and much like chocolate icecream might be the evil treat any woman would want to sneak and enjoy full heartedly, any nice cool drink is that evil treat for me .. and when I am thirsty and I know it is in my fridge ... somehow I never used to see drinks this way   Of course I would be just as bad with chocolate icecream so I just don't buy that 

[kitkatz]

I spend most of my time at home, so I am always bored. If I could do more things I would forget that Im thirsty or hungry. Im just too tired to do anything.

I think if you got up and did one thing each day you would feel better.  I mean one thing you do NOT usually do.  I clean house by doing one room at a time.  It is not as big a project as it would be if I looked at the entire house at once.

[Panda_9]

Angie I purposely don't keep cold water or juice in the fridge because of the temptation. I totally love cold water and if its there I will polish it off in one sitting. Now I just have to stop drinking all the cold milk!

When I am cleaning I stick to one room at a time too. If I think about the whole house, it seems unachievable. I have been doing some things, but not alot. There is stuff all to do around here that doesn't cost an arm and a leg. Summer is approaching fast which for me means a heap less energy. At least now I can go swimming and can start water aerobics again.

[angieskidney]

Angie I purposely don't keep cold water or juice in the fridge because of the temptation. I totally love cold water and if its there I will polish it off in one sitting. Now I just have to stop drinking all the cold milk!

Yes, that is why I got rid of all milk and never buy it My mom used to bring over milk (she thought I was helping me out and kept forgetting I can't have certain things) and of course I didn't want to waste it .. but my dietitian got mad at me about it ... even though I didn't have a lot of money and couldn't afford to get things ...

I did appreciate my mom's help .. but MILK?? I ended up getting upset with my Dietitian til she understood my position. Now my mom no longer brings me milk. I think she finally understands.

[Russ]

I concur with Zach and BigSky.  I'm 6'7" and my dry weight is 229 kilos.(not a typo)   I'm sure I'm the largest patient my center has ever dealt with.  After a year on dialysis, my doctor is finally thinking out of the box and has figured out I'm not an 90 pound little ol' lady. (no offense to the 90# ladies)  I typically gain 5 kilos (2%) between treatments and the techs are authorized to pull as much as 8 kilos (3.5%) for me.  I've gained as much as 7.3 kilos over the weekend.  With a .6 kilo rinse for 2 parallel kidneys, that's close to 8 kilos.

[goofynina]

Heya Russ, dont feel bad amigo,  the most i ever gained was over the New Year Holiday and it was 15 kilos    it is so easy to do so be verrrry careful,  i think i have broken records myself 

[Panda_9]

Holy shit!!! The most Ive gained is 7kg and it was only because my machine broke down and ER kept sending me home saying your ok. Then when I finally got to do a run incenter, they dialed in my fluid wrong, and only ended up taking off a couple of 100mls.

I dont see how a doctor would authorise an 8 kilo UF? I gain up to 4kgs which is really bad, I couldnt breathe if I gained that much.