Blood pressure as a guide to Ideal (Dry) weight

[Bruno]

Over the past week or so I've noticed my blood pressure pre dialysis has been in the 155 to 160's which I know is regarded as high by my clinic's guidelines.
It occurred to me that this might mean my ideal weight needed review, so I decided to come down from 108 kg, and the next session (yesterday) I went for 107.5 but ended up 107 kg.
My BP at session end was 119/69 and the next day (a non session day) it was 133/82 so it would appear there is a relationship between BP and dry weight.
There are few guides to knowing when to reduce weight so is this one? And are there others that you have found useful?
If its any help to you in thinking about my question, I always run to a schedule that looks for a session goal of 2000ml  and a uf rate of under 400.
This means I don't experience low BP (under 100) or cramps so I have little to go on in making an ideal weight estimate.

[rsudock]

I think using your BP as a guide to your dry weight is smart. When I was staying near my dry weight my BP was hardly over 130/90s. Of course when I first started D I had a hard time controlling the BP but with Norvasc and lowering my dry weight it was much better controlled near the end of my dialysis journey.

Another thing that helped me determine dry weight was how I felt the next day after D. If I was really nauseous and sick to my stomach, I knew I was probably a little to dry.

xo,
R

[Stoday]

With a bit of experience you can feel when you're getting dry.

I feel I'm getting dryed out sometimes mid-dialysis, around 2 hours. Then I get the nurse to reduce the ultrafiltration rate. If I've got the right UF profile, this won't happen.

Towards the end, in the last hour, if I feel I'm drying out I ask to stop UF. In that case, weighing in at the end gives my dry weight.

If I don't stop UF in time, I'll cramp.

Seems to work OK for me.

[Riki]

That's generally what's used in my unit.  It seems that if your bp is high, and you can take off a little extra without crashing or cramping, lowering your dry weight isn't a bad idea.

My experience with this lately, was kind of the opposite.  My weight increased, so my dry weight had to go up.  The way we figured this out was the nurses tried to go for my dry weight, which was 100kg, and about halfway through the run, my bp dropped like a stone.  They took me out of profile, and left me in minimum for a while, then increased my dry weight to 102.5kg.

What this tells me is, I need to lose weight. *L*

[Bruno]

That last line of Ruth Dock startled me...I've got my dry weight and blood pressure down, but I've felt so sick and nauseous that life hasn't seemed worthwhile.
Funny how when you're crook in the guts you get depressed.
I'm going to add 'sick in the stomach' and 'nauseous' to my too much weight off indicators.
And Rikki, I think you are right too, I tried to go from 108 kg to 107 kg, then 107.5 kg, and now it looks as though I'm back at 108 kg.
My neph, who's a great gal, says that staying at dry weight is a black art and I'm beginning to think she's right.

[jbeany]

Too dry - queasy, light headed, getting that swooping blackout sensation when you stand up too fast, even the next day.  Headaches, excessive dry mouth.  Anytime a 1/4 cup of salt broth drastically improves any of those symptoms, you've probably run yourself too dry.

Too wet - everyone has a different "poofy" spot.  My ankles would be fine, but my fingers swelled.  Take a good look at what swells first for you.  BP is another good measure, of course, but not a perfect one, since stress and changes in meds can affect your bp as well as the extra fluid.  If you are leaving at the end of the run and you still have edema, even a little bit, it's time to push your dry weight again.

You can challenge your dry weight in tiny increments, too.  Have them set your goal .2 or .3 under your regular dry weight.  Work your way down slowly.  There really isn't that much rush, and it lessens your chances of a massive crash.  I was trying to lose weight the entire time I was on D, so most runs, I was trying to push my weight down a notch.  Train your nurses to let you set your goals.  It takes a bit, but they usually get in the groove when they see you know what you are talking about.

[M3Riddler]

Over the past week or so I've noticed my blood pressure pre dialysis has been in the 155 to 160's which I know is regarded as high by my clinic's guidelines.
It occurred to me that this might mean my ideal weight needed review, so I decided to come down from 108 kg, and the next session (yesterday) I went for 107.5 but ended up 107 kg.
My BP at session end was 119/69 and the next day (a non session day) it was 133/82 so it would appear there is a relationship between BP and dry weight.
There are few guides to knowing when to reduce weight so is this one? And are there others that you have found useful?
If its any help to you in thinking about my question, I always run to a schedule that looks for a session goal of 2000ml  and a uf rate of under 400.
This means I don't experience low BP (under 100) or cramps so I have little to go on in making an ideal weight estimate.

Bruno,

Yes there is a connection between blood pressure and your dry weight.  When you have fluid on board, your vessels swell, thus raising your blood pressure.  When you pull off too much fluid, the pressure will fall.
Another measure that can be used, more on the hemo side, but I'm sure on the PD side as well is your pulse rate. A higher pulse usually tells you that you are pulling too much off or have reached your dry weight. You may want to ask your nephrologist if pulse can be used as a measure of dry weight as well.... As I stated, it is definitely used on the hemo side along with blood pressure...

///M3R

[Riki]

Another measure that can be used, more on the hemo side, but I'm sure on the PD side as well is your pulse rate. A higher pulse usually tells you that you are pulling too much off or have reached your dry weight. You may want to ask your nephrologist if pulse can be used as a measure of dry weight as well.... As I stated, it is definitely used on the hemo side along with blood pressure...

///M3R

Is this why sometimes the doctor will look at your neck to see if you're holding fluid?

[Ang]

its fairly easy if your BP is in the normal range(130/90) then your ibw is pretty good to , unless you have a pre determined

BP issue

[Bruno]

Well, you know I started at 108 kg ?  My finish reading yesterday was 106.6 with a BP of 144/74, so I obviously haven't got there yet. My nurse said an interesting thing, I'll know I'm there when I get low BP in the last hour because during this time you actually go below your IW because when you come off you put your blood back with a shot of saline which can equal 400ml.
So the weight you have at finish is actually 400ml higher than the weight you were at during dialysis.

[M3Riddler]

Well, you know I started at 108 kg ?  My finish reading yesterday was 106.6 with a BP of 144/74, so I obviously haven't got there yet. My nurse said an interesting thing, I'll know I'm there when I get low BP in the last hour because during this time you actually go below your IW because when you come off you put your blood back with a shot of saline which can equal 400ml.
So the weight you have at finish is actually 400ml higher than the weight you were at during dialysis.

Bruno,
This sometimes defeats the purpose of removing fluid for those who are in-center.... When they start feeling sick or have a bp drop, they give them a bolus ( or more) of saline.... This totally defeats the purpose of any fluid you have removed earlier... Its like a roller coaster...you are going to remove fluid, but they end up giving you some and sometimes it ends up being more than what you walked in with...
One method to help this is by removing less fluid per hour and spreading it out more over the course of the whole treatment... Removing anything over 400cc's (.4 liters) or round that amount give or take a few hundred cc's is defeating the purpose and putting stress on your heart.
Depending on your size and a few other factors, the bloodstream can only hold a certain amount of fluid at one time. So no matter how much you try to pull off per hour, you are just stressing the veins and heart. 
This is one reason why you may see some people crash at the end of their treatments.... They have removed too much fluid off too fast..

[talker]

Wowie, another oldie but goodie. 

Way back in the early days of starting dialysis, I had numerous 'crashes'. 
Now that I've put a tad of experience under the belt, my quality of life is fairly constant.     
Currently most warning signs are in the last hour of dialysis. A request to make machine adjustments during that last hour is a must for me.

My criterion is  'quality of life' after dialysis and the next day after dialysis.
 If any real variations are taking place, I am super vigilant the next dialysis session.

I use the home weigh in for setting the dialysis centers 'dry' weigh in process, to set 'how much they actually remove in any session. 

talker

[estonb]

Ah, "dry weight". I have always hated that term. It makes me think of someone running around with absolutely no water in their body! No one can ever really be "dry" because there always needs to be some water in the bloodstream in order for the vascular system to operate effectively. I wish they would change the name to something like "optimal water weight" or "minimal water weight".

Anyway, back to the real topic....

I definitely agree - finding a person's dry weight is really a black art. I.too, typically use my BP to gauge if I am at or near my dry weight. I am a bird of a slightly different color, however, because I have Superior Vena Cava Syndrome, or SVCS,  (which means that I have a large clot in my Superior Vena Cava - the large vein that drains your entire upper vascular system into your heart; there is also a corresponding Lower Vena Cava that drains your entire lower body's vascular system into your heart), thus all of my fluid collects around my chest, neck, and face. I try my hardest to leave D as dry as possible to avoid the very unattractive effect of having extra fluid in the neck and face tissue. This means that I really have to push my BP as low as I can tolerate before I stop pulling off fluid. For me, once my BP drops into the 90's I know that I am getting very close to leaving D as dry as I can comfortably tolerate. sometimes I even let it get into the 80's.

I am definitely not recommending that others allow their BP to get that low, I am just saying what works for me. I guess I am one of the lucky ones that have never crashed, much less even felt close to crashing, very rarely cramp (even when I do it is only minor), and never get sick to my stomach.

The only way I know I am getting as dry as possible is by letting myself get into those low blood pressure areas. I definitely agree that if one is trying to determine one's own dry weight that they should push themselves in small increments. If I think my dry weight has changed (either up or down), I usually change my UF goal by 200ml a session and see what the outcome is. If, after that test, I think I need to take off more or less to find my dry weight, then I take off another 200ml and so on until I think my BP is in the range where I want it to be.