What is acceptable gain?

[Bajanne]

I have been doing quite badly on weekends, and this weekend in St. Thomas, US Virgin Islands was not different.  I came to dialysis with 5.5 over my dry weight.  The rule in our centre is that they do not take off more than 4 at any one time.  So I came home heavier than my dry weight.
That means I have to be overcareful with my liquid intake.
Boy oh boy...........................

[angieskidney]

Holy crap angie, what UF rate is that? Your max that is.

No the max UF rate at my unit is 5.5kg but I don't like to max out like that because my BP drops.

I have been doing quite badly on weekends, and this weekend in St. Thomas, US Virgin Islands was not different. I came to dialysis with 5.5 over my dry weight. The rule in our centre is that they do not take off more than 4 at any one time. So I came home heavier than my dry weight.
That means I have to be overcareful with my liquid intake.
Boy oh boy...........................

Wow that will be a challenge. I know once when I was 1kg up I kept coming in heavy for the next 2 days

[AlasdairUK]

This weekend I set my record of 3.6 with the washback. looks like I'm a small potato compared to some of you. I try to keep it between 2-3 kg with the washback. I think I would die if I took off 4kg.

[Panda_9]

Holy crap angie, what UF rate is that? Your max that is.

No the max UF rate at my unit is 5.5kg but I don't like to max out like that because my BP drops.

I have been doing quite badly on weekends, and this weekend in St. Thomas, US Virgin Islands was not different. I came to dialysis with 5.5 over my dry weight. The rule in our centre is that they do not take off more than 4 at any one time. So I came home heavier than my dry weight.
That means I have to be overcareful with my liquid intake.
Boy oh boy...........................

Wow that will be a challenge. I know once when I was 1kg up I kept coming in heavy for the next 2 days

I mean your actual UF rate per hour, not total UF.

[angieskidney]

I mean your actual UF rate per hour, not total UF.

What is the difference??

[Panda_9]

Total UF is the "total" amount of fluid you want to take off. UF rate is the amount of fluid taken off per hour.
For example, say you want to dial in 3 litres to take off and you are doing 4 hours. Divide 3L by 4hrs and you get 750ml per hour.
Get it now? Im surprised you dont know this considering you are in a self care unit!

[Epoman]

The main problem is not BP or how much you can handle to take off. The main problem is that those of you doing 3 times in center a week removing 4 or 5 kilos each session are doing damage to your heart. You are ENLARGING your heart and you will suffer from it years down the road. Just ask me I did in-center 13 years and removed about 4 kilos every time and now I have a VERY enlarged heart. This is the one of the biggest problems we patients face is Cardio problems and that is what will "take" a lot of us. They can still dialyze our kidneys long after our heart stops, but would good would it do?

Now that I am home doing dialysis (ilovenxstage.com) 5 or 6 times a week, I remove on average 1.0 to 2.0 kilos each time. Which is much better on your heart. I take off ALL the fluid the first 2 hours (my treatment is usually 2:25) in those two hours I am taking on average only .5 to 1.0 kilo off an hour which is very good and will NEVER cause me to go "flat" or pass out. When I eventually do Nocturnal I will be taking off so little every hour my body would even notice. For example if I am running 8 hours on Nocturnal, and I need to remove 2 kilos, well that is just 0.25 kilos an hour.  Now imagine if I need to only remove 1.0 kilo in 8 hours. 

I am not trying to turn this into a Nocturnal thread, it's just that I am trying to prove a point, removing 4 or 5 kilos in 3 hours is VERY bad on the heart and WILL indeed cause damage, if you do it many years. Like I said I am suffering the consequences of it now.

[angieskidney]

Total UF is the "total" amount of fluid you want to take off. UF rate is the amount of fluid taken off per hour.
For example, say you want to dial in 3 litres to take off and you are doing 4 hours. Divide 3L by 4hrs and you get 750ml per hour.
Get it now? Im surprised you dont know this considering you are in a self care unit!

My dialysis machine is different. We don't have dials to dial anything in lol
  My Hemo is the Fresenius 2008K

I weigh myself ... and I already know my target for my dry weight is 63.5kg. Then if I go in and my weight is 66.7kg then I know I need to take off 3.2kg (3200ml)in the 3 and a 1/2 hrs I am on my machine. Then I also have to calculate the runback (or rinseback as Americans call it ) which is 400ml so that brings it up to 3.6kg (3600ml) coming off. Then I must also calculate in my drinks that I have during dialysis ... the tea I bring which is 300ml and also the ice water or tea that someone brings me afterwards during my run is about 200ml.  So now that brings me up to 4100 ... just like in this pic I attached. As you can see the UF Rate is 1170 if I have 4.1 taken off of me in 3:30hrs. The machine calculates this for me so I don't have to do any of the division you were talking about

Actually they still haven't taught me everything there is to know for a self care unit Seems Canada is understaffed 

  66.7
-63.5
--------
  3.2
+  .4
--------
  3.6
+  .3
--------
  3.9
+  .2
--------
  4.1

Now that I am home doing dialysis (ilovenxstage.com) 5 or 6 times a week, I remove on average 1.0 to 2.0 kilos each time. Which is much better on your heart. I take off ALL the fluid the first 2 hours (my treatment is usually 2:25) in those two hours I am taking on average only .5 to 1.0 kilo off an hour which is very good and will NEVER cause me to go "flat" or pass out. When I eventually do Nocturnal I will be taking off so little every hour my body would even notice. For example if I am running 8 hours on Nocturnal, and I need to remove 2 kilos, well that is just 0.25 kilos an hour.  Now imagine if I need to only remove 1.0 kilo in 8 hours. 

I am not trying to turn this into a Nocturnal thread, it's just that I am trying to prove a point, removing 4 or 5 kilos in 3 hours is VERY bad on the heart and WILL indeed cause damage, if you do it many years. Like I said I am suffering the consequences of it now.

Epoman, that post is sooo informative that I am going to quote you on D&T City with your permission. May I?

[Panda_9]

The main problem is not BP or how much you can handle to take off. The main problem is that those of you doing 3 times in center a week removing 4 or 5 kilos each session are doing damage to your heart. You are ENLARGING your heart and you will suffer from it years down the road. Just ask me I did in-center 13 years and removed about 4 kilos every time and now I have a VERY enlarged heart. This is the one of the biggest problems we patients face is Cardio problems and that is what will "take" a lot of us. They can still dialyze our kidneys long after our heart stops, but would good would it do?

Now that I am home doing dialysis (ilovenxstage.com) 5 or 6 times a week, I remove on average 1.0 to 2.0 kilos each time. Which is much better on your heart. I take off ALL the fluid the first 2 hours (my treatment is usually 2:25) in those two hours I am taking on average only .5 to 1.0 kilo off an hour which is very good and will NEVER cause me to go "flat" or pass out. When I eventually do Nocturnal I will be taking off so little every hour my body would even notice. For example if I am running 8 hours on Nocturnal, and I need to remove 2 kilos, well that is just 0.25 kilos an hour.  Now imagine if I need to only remove 1.0 kilo in 8 hours. 

I am not trying to turn this into a Nocturnal thread, it's just that I am trying to prove a point, removing 4 or 5 kilos in 3 hours is VERY bad on the heart and WILL indeed cause damage, if you do it many years. Like I said I am suffering the consequences of it now.

How is taking 0.5-1.0L off per hour BETTER? You can still definitely go flat at that rate. 1L per hour is an excessive UF rate and is no different to doing 1L per hour in centre over 3-4hrs. Obviously gaining only 0.5-1L is excellent as far as the heart goes, but ripping it off at 1L per hour absolutely can cause you to go flat.

[BigSky]

As to what is excessive fluid removal depends all on the person.  Personally 1L is not all that much in an hour. I can easily sweat 1L an hour off working out.   Even when my kidneys worked and I had normal fluid balance it was easily to sweat off 2L or more while working out for an hour.  So I really see no difference between sweating out 1L a hour over that of a machine taking off 1L a hour.


There is more to going flat than just fluid removal.

Studies have shown that many patients tend to heat up while on dialysis, which has been shown to cause people to go crash.  They are not sure why this happens because the body is not actually doing anything physical that would cause the body to heat up.  Shorter run time means less time the body heats up.  Studies have shown fluid is removed much more easily and there are less episodes of people crashing or having low blood pressure if the machine dialysate temp is turned down.  So I would think that the less run time that Epoman has produces less heat and combined with limited fluid removal it helps him from crashing.   

[Russ]

The main problem is not BP or how much you can handle to take off. The main problem is that those of you doing 3 times in center a week removing 4 or 5 kilos each session are doing damage to your heart. You are ENLARGING your heart and you will suffer from it years down the road. Just ask me I did in-center 13 years and removed about 4 kilos every time and now I have a VERY enlarged heart. This is the one of the biggest problems we patients face is Cardio problems and that is what will "take" a lot of us. They can still dialyze our kidneys long after our heart stops, but would good would it do?

Now that I am home doing dialysis (ilovenxstage.com) 5 or 6 times a week, I remove on average 1.0 to 2.0 kilos each time. Which is much better on your heart. I take off ALL the fluid the first 2 hours (my treatment is usually 2:25) in those two hours I am taking on average only .5 to 1.0 kilo off an hour which is very good and will NEVER cause me to go "flat" or pass out. When I eventually do Nocturnal I will be taking off so little every hour my body would even notice. For example if I am running 8 hours on Nocturnal, and I need to remove 2 kilos, well that is just 0.25 kilos an hour.  Now imagine if I need to only remove 1.0 kilo in 8 hours. 

I am not trying to turn this into a Nocturnal thread, it's just that I am trying to prove a point, removing 4 or 5 kilos in 3 hours is VERY bad on the heart and WILL indeed cause damage, if you do it many years. Like I said I am suffering the consequences of it now.

Epoman, I'm starting NxStage in December but I didn't know nocturnal was an option with it.  Why haven't you started nocturnal already?  Do you need a partner to stay awake during the night to watch you?

[Panda_9]

Total UF is the "total" amount of fluid you want to take off. UF rate is the amount of fluid taken off per hour.
For example, say you want to dial in 3 litres to take off and you are doing 4 hours. Divide 3L by 4hrs and you get 750ml per hour.
Get it now? Im surprised you dont know this considering you are in a self care unit!

My dialysis machine is different. We don't have dials to dial anything in lol
  My Hemo is the Fresenius 2008K

I weigh myself ... and I already know my target for my dry weight is 63.5kg. Then if I go in and my weight is 66.7kg then I know I need to take off 3.2kg (3200ml)in the 3 and a 1/2 hrs I am on my machine. Then I also have to calculate the runback (or rinseback as Americans call it ) which is 400ml so that brings it up to 3.6kg (3600ml) coming off. Then I must also calculate in my drinks that I have during dialysis ... the tea I bring which is 300ml and also the ice water or tea that someone brings me afterwards during my run is about 200ml.  So now that brings me up to 4100 ... just like in this pic I attached. As you can see the UF Rate is 1170 if I have 4.1 taken off of me in 3:30hrs. The machine calculates this for me so I don't have to do any of the division you were talking about

Actually they still haven't taught me everything there is to know for a self care unit Seems Canada is understaffed 

  66.7
-63.5
--------
  3.2
+  .4
--------
  3.6
+  .3
--------
  3.9
+  .2
--------
  4.1

Now that I am home doing dialysis (ilovenxstage.com) 5 or 6 times a week, I remove on average 1.0 to 2.0 kilos each time. Which is much better on your heart. I take off ALL the fluid the first 2 hours (my treatment is usually 2:25) in those two hours I am taking on average only .5 to 1.0 kilo off an hour which is very good and will NEVER cause me to go "flat" or pass out. When I eventually do Nocturnal I will be taking off so little every hour my body would even notice. For example if I am running 8 hours on Nocturnal, and I need to remove 2 kilos, well that is just 0.25 kilos an hour.  Now imagine if I need to only remove 1.0 kilo in 8 hours. 

I am not trying to turn this into a Nocturnal thread, it's just that I am trying to prove a point, removing 4 or 5 kilos in 3 hours is VERY bad on the heart and WILL indeed cause damage, if you do it many years. Like I said I am suffering the consequences of it now.

Epoman, that post is sooo informative that I am going to quote you on D&T City with your permission. May I?

Sorry angie, didnt mean to confuse you lol I dont have to calculate my UFR either, the machine does that. However, I know if I go over a certain rate, I will most definitely go flat or feel like total shit. At the moment anything more than 600-700ml/hr drops my BP. The only time I have done 1L or more per hour is in the HDU with them monitoring it and me laying upside down.

[Panda_9]

As to what is excessive fluid removal depends all on the person.  Personally 1L is not all that much in an hour. I can easily sweat 1L an hour off working out.   Even when my kidneys worked and I had normal fluid balance it was easily to sweat off 2L or more while working out for an hour.  So I really see no difference between sweating out 1L a hour over that of a machine taking off 1L a hour.


There is more to going flat than just fluid removal.

Studies have shown that many patients tend to heat up while on dialysis, which has been shown to cause people to go crash.  They are not sure why this happens because the body is not actually doing anything physical that would cause the body to heat up.  Shorter run time means less time the body heats up.  Studies have shown fluid is removed much more easily and there are less episodes of people crashing or having low blood pressure if the machine dialysate temp is turned down.  So I would think that the less run time that Epoman has produces less heat and combined with limited fluid removal it helps him from crashing.   

Sweating and UF-ing on dialysis are completely different. When you go flat on Dx, it is because the fluid shifts in the cells cant replace lost fluid into the bloodstream as quick as it is being removed.

[Panda_9]

You dont need anyone to watch you overnight Russ. It might not be the same in your area but over here, you go home on day time dialysis for a couple of months (sometimes less) and then you will be bought in for 2 nights to train for nocturnal. There isnt a great deal of a difference as compared to day time Dx. Just a few little things. Again I dont know if NxStage is different, I am guessing you might need alot more fluid bags. The important thing is that you are keeping an eye on any weight loss or gain, and your BP. We are not to run at a UFR of more than 400ml/hr so you dont go flat. I am a little sceptical though, as I have gone flat on nocturnal once, I am just glad it was at the hospital. 

[angieskidney]

Sorry angie, didnt mean to confuse you lol I dont have to calculate my UFR either, the machine does that. However, I know if I go over a certain rate, I will most definitely go flat or feel like total shit. At the moment anything more than 600-700ml/hr drops my BP. The only time I have done 1L or more per hour is in the HDU with them monitoring it and me laying upside down.

Well I can handle 1 - 1.5L/hr easily. Everyone is different. I don't know if you are smaller than me (I am 5'5" 138lbs) but I just know what I can handle.

[Russ]

You dont need anyone to watch you overnight Russ. It might not be the same in your area but over here, you go home on day time dialysis for a couple of months (sometimes less) and then you will be bought in for 2 nights to train for nocturnal. There isnt a great deal of a difference as compared to day time Dx. Just a few little things. Again I dont know if NxStage is different, I am guessing you might need alot more fluid bags. The important thing is that you are keeping an eye on any weight loss or gain, and your BP. We are not to run at a UFR of more than 400ml/hr so you dont go flat. I am a little sceptical though, as I have gone flat on nocturnal once, I am just glad it was at the hospital. 

I may be out of luck in doing nocturnal with NxStage as nobody in the Chattanooga area offers nocturnal training (on any type machine) at this time.

[BigSky]

Sweating and UF-ing on dialysis are completely different. When you go flat on Dx, it is because the fluid shifts in the cells cant replace lost fluid into the bloodstream as quick as it is being removed.

I am sure there are some finer points to it and I agree they are different, however only  to the degree of the process IMO.

The results end up being the same for too much fluid being removed, and not being replaced, which results in reduced blood volume.  Cramping, nausea, low bp.

From my understanding one process is where the blood takes its fluid from the interstitial space (dialysis) and the other is where the interstitial space takes if from the blood (sweating).

[AlasdairUK]

As far as I know, fluid can move from tissue to your blood at a maximum of 400 ml per hour. So if you UF rate is bigger than that you are always going to lose fluid from your plasma as the body can not shift it fast enough from the tissue. This is what causes your BP to drop as your blood actually loses volume. If you are well balanced you will have a similar pre and post BP.

[angieskidney]

Ya mine drops near the end but since I am no longer on BP meds it doesn't drop below 100/60

[sandman]

As far as I know, fluid can move from tissue to your blood at a maximum of 400 ml per hour.

Is this a fact or is this what you are let to believe?  Can you tell me how you came across this information?

[Panda_9]

Sorry angie, didnt mean to confuse you lol I dont have to calculate my UFR either, the machine does that. However, I know if I go over a certain rate, I will most definitely go flat or feel like total shit. At the moment anything more than 600-700ml/hr drops my BP. The only time I have done 1L or more per hour is in the HDU with them monitoring it and me laying upside down.

Well I can handle 1 - 1.5L/hr easily. Everyone is different. I don't know if you are smaller than me (I am 5'5" 138lbs) but I just know what I can handle.

Holy crap angie, I dont even know if they allow UFs that high here, unless its in HDDU. I am bigger than you, and have low BP at the moment. I still dont go over 700ml though, even thats too much, makes me feel like Ive been hit by a truck.

[AlasdairUK]

As far as I know, fluid can move from tissue to your blood at a maximum of 400 ml per hour.

Is this a fact or is this what you are let to believe? Can you tell me how you came across this information?

I found this site which is good at explaining how dialysis works. This is the link to the rate fluid moves between cells.

http://www.nocturnaldialysis.org/lowbp.htm

[angieskidney]

As far as I know, fluid can move from tissue to your blood at a maximum of 400 ml per hour.

Is this a fact or is this what you are let to believe? Can you tell me how you came across this information?

I found this site which is good at explaining how dialysis works. This is the link to the rate fluid moves between cells.

http://www.nocturnaldialysis.org/lowbp.htm

EXTREMELY good link!! 

[sandman]

I found this site which is good at explaining how dialysis works. This is the link to the rate fluid moves between cells.

http://www.nocturnaldialysis.org/lowbp.htm

Thanks AlasdairUK.  Very informative link. 

[BigSky]

As far as I know, fluid can move from tissue to your blood at a maximum of 400 ml per hour.

Is this a fact or is this what you are let to believe?  Can you tell me how you came across this information?

That number is still true for some.  That was evidently one of the reasons patients were told not to drink more than 1-1.5 kilos between treatments.  So that fluid transfer between interstitial space and the blood was kept in check.

However it doesn't take into account that patients are over-hydrated and have a greater blood volume than normal at the start of dialysis.  Also that larger patients have more interstitial space to release fluid from and therefore are able to release more than 400ml per hour back to the blood.

This makes it important that patients, especially those that drop bp, be monitored with a crit-line or similar machine to make sure they are at a true dry weight and that the fluid is coming off in a manner that does not drop blood volume too fast for the interstitial spaces to release fluid back into the blood.  This does not seem to be a common thing done for many patients.

A true dry weight (ideal) is a weight where one would be without kidney failure.  Meaning that after dialysis if one was to work out they could sweat a liter off without having any affects of low blood volume (low bp).