Urine-output whilst on dialysis ?

[kristina]

Hello,
It is not clear to me yet, whether in all cases urine-output always seizes after at some point along the road of dialysis?
Or, has it been known that urine-output can continue indefinitely whilst on dialysis?
From my observations so far in the dialysis-centre it would appear that those still with urine-output have less problems and a more comfortable journey
in comparison to those with no urine-output. Could this be a fair comment?
From this the question naturally arises how to keep urine-output going whilst on dialysis?
So my question is has anyone had any ideas about how to keep urine-output going whilst on dialysis
whether this comes from positive experience or ideas about what someone would have liked to  have done to achieve urine-output despite dialysis.
For example one idea is to stimulate the kidneys etc. into producing urine and expelling it?

Thank you from Kristina.

[Michael Murphy]

For a short time I stopped creating Urine it was during the period that they were trying to kill me.  As a fat person my doctor incorrectly set my dry weight so they were taking 4 or 5 kilos off every Dialysis session And limited me to 40 OS OF fluid a day.  Eventually I went to a doctors visit And may Bp was 75/45. Afterward day may drt weight was raised  way up so they only remove a kilo each session.  I began to create Urine again.  Dialysis is easier if you create urine.  My blood work is usully perfect with only minor tweaking.  The problem is most but not all people gradually decrease output.  However I try to protect what kidny function I have because it is a blessing to not be fluid restricted.  I have been tod by a doctor that since I will loose it eventually I should no insist on protecting them so much.  I no longer will see this doctor and will wait for my regular nephrologist since my quality of life is effected by having a partially functioning set of kidneys.  To check to see if I need to change anything once a month I measure input and output to see if they still match. 

[obsidianom]

Hello,
It is not clear to me yet, whether in all cases urine-output always seizes after at some point along the road of dialysis?
Or, has it been known that urine-output can continue indefinitely whilst on dialysis?
From my observations so far in the dialysis-centre it would appear that those still with urine-output have less problems and a more comfortable journey
in comparison to those with no urine-output. Could this be a fair comment?
From this the question naturally arises how to keep urine-output going whilst on dialysis?
So my question is has anyone had any ideas about how to keep urine-output going whilst on dialysis
whether this comes from positive experience or ideas about what someone would have liked to  have done to achieve urine-output despite dialysis.
For example one idea is to stimulate the kidneys etc. into producing urine and expelling it?

Thank you from Kristina.

You may continue urinating for years. My wife still does after almost 3 years on dialysis. Some of it is luck. But not removing too much fluid during dialysis may also help. That allows the kidneys to still try to produce urine. WE remove almost no fluid during dialysis.   
You are correct in that urination continuing makes the process easier on the body with fewer restrictions. I am glad my wife still does. It is easier for her on dialysis then many other patients.

[kristina]

Thank you very much Michael Murphy and obsidianom for your helpful replies, it is very much appreciated.
I shall make a point of not having too much fluid removed in the future, to be able and retain my regular "water-output".
Until now I had 2 and a half litres removed at dialysis, but that was because I suffered from too much water-retention building up,
before I even started with dialysis. That water has to come off now and I reckon I shall need another 2 and a half litres removed
to be almost "back to normal"  again about the water retention.
Thanks again from Kristina.

[Darthvadar]

My late mum never stopped urinating!... In fact if peeing had been an Olympic Sport, Mum would have taken home the gold medal!... That woman could pee for Ireland!... A usual Incontinence pad (Super Absorbency) requirement was about six per day, along with what she was able to produce during regular toileting...

She wasn't ridding herself of toxins, though... Just fluid... I suppose I can best describe it as producing but not clearing...

It made things much easier with fluid restrictions not being an issue, but she was on PD most of the time, so that probably helped...

All I can say from what I hear is, keep going... Anything you can do naturally can only help!...

Darth....

[iolaire]

Sorry I don't know how to continue urine output, but that will not stop me from sharing.

I get the feeling that my urine output will decline similar to my kidneys, slowly... I've been on for a year now, and I think that I'm outputting a little bit less urine but them I'm also drinking a bit less - but its still a good amount and say 3-5 times per night.  I expect that I'll really need to watch things once I start to see some true water retention and see the water in my legs and such.

[Charlie B53]

I am not a Dr, nor did I stay at a Holiday Inn last night.  But I suspect urine output reduction relates to remaining kidney function, how much damage there is and how fast the kidneys continue to deteriorate.  Anything we can do to slow the progression of the disease, condition causing the kidney failure, shoudl help extend the time the kidney do function.  In my case.  way too many years of anti-inflammatory meds, and the high blood pressure, AND the daily dehydration, together caused a LOT of irrecoverable damage.  Now add that I've become diabetic, it isn't any better.

Strict attention to BP, sugars, hydration, and no more kidney UN-friendly meds, I may keep making urine for a very long time.  Hopefully.  There isn't any guarantee.  Just hope.

[kristina]

Thanks again for sharing your experiences, Darthvadar, iolaire and Charlie B53. I do appreciate it very much!
I was wondering about this because most people in "my" dialysis-centre don't have any urine-output any longer,
even though they have been on dialysis for a a few weeks only and I really wondered why
because my natural kidney function is less than theirs,
but I still have a good natural urine-output and my water-retention is also slowly getting off,
and I guess I only need another 2 litres taken off to be hopefully ok.
I also guess that it depends if a patient remains to be able to " go" to the toilet,
it depends of how much fluid-retention is taken off through dialysis in one session ...
I was also wondering how much fluid people on dialysis generally drink?
Does the fluid-intake depend on the remaining kidney-function, or the general weight of the patient,
or does it depend on something else?
I am also wondering how exactly the dry weight is determined? Is it dependent on a guess?
Or is there a possibility to determine is precisely?
Thanks again from Kristina.

[iolaire]

We know my dry weight because I cramp when under it, when over I have no cramping. Also bp will be too low.

I think many people start dialysis as a surprise after major kidney problems that put them in the hospital. Those of us that are prepared for dialysis do less damage to the kidney in the time just before dialysis.  That's my idea.

[chuckdims]

I peed like a champ my first six months or so on dialysis.  Then it started to taper off.  Now, I pee a few tablespoons most days, some days not at all.

The other day I was at Target and I had this strange feeling.  I couldn't identify it.  I realized I had to pee!  I went and it lasted about 10 seconds.  That's the longest pee I have had in a very long time.  I went back out and told my wife and she gave me a high five.  Then I realized people overheard me and that they were looking at us very confused...

[obsidianom]

Thanks again for sharing your experiences, Darthvadar, iolaire and Charlie B53. I do appreciate it very much!
I was wondering about this because most people in "my" dialysis-centre don't have any urine-output any longer,
even though they have been on dialysis for a a few weeks only and I really wondered why
because my natural kidney function is less than theirs,
but I still have a good natural urine-output and my water-retention is also slowly getting off,
and I guess I only need another 2 litres taken off to be hopefully ok.
I also guess that it depends if a patient remains to be able to " go" to the toilet,
it depends of how much fluid-retention is taken off through dialysis in one session ...
I was also wondering how much fluid people on dialysis generally drink?
Does the fluid-intake depend on the remaining kidney-function, or the general weight of the patient,
or does it depend on something else?
I am also wondering how exactly the dry weight is determined? Is it dependent on a guess?
Or is there a possibility to determine is precisely?
Thanks again from Kristina.

Unfortunatly dry weight is somewhat of a guess. Its an art, not a science. You get a feel for it over time. If you can measure your daily urine output you can better figure out how much fluid you can intake . Remember if you take in more then you urinate out, you have to remove the extra through the dialysis machine .

[kristina]

Thank you very much iolaire, chuckdims and obsidianom.
I am now getting the idea and I reckon I have to make regular check-ups
on my fluid-input and output to find out how much my kidneys are still functioning,
in order to regulate the amount of water-retention taken off with dialysis
to arrive at a point of balance for my dry-weight.
Thank you very much again from Kristina.

[Charlie B53]

My urine output varies with my fluid intake and steriod dose.  Prior to the steroid I was producing a liter at most.  Drinking much more than that and I may 'see' a small amount of swelling just above the ankles.  I check them daily, if too much then I may have to increase the sugar % for that nights exchange, which I do not want to do as the increased sugars can cause wear and tear on the membrane.  So I watch closely.  Fortunately so far I can drink pretty much what I want.

When I first started the prednisone my urine output about tripled!  I was amazed.  But then again, I noticed I was eating and drinking far more than before.  Since my dose has been cut down I am getting back to what's 'normal' for me.  I've lost 16 of the 18 pounds I gained with the high dose of steriod, and my urine output has dropped to my 'usual 1/2 liter daily.

Still don't know what my 'final' dry weight will be as I am slowly losing fat.  Figure I have at least another 20 pounds.  Give it another year and see.

Over the summer on a couple of occasions I got a little too dry.  Dizziness when I bent over to pick up anything in the yard.  A can of chicken noodle soup had enough salt I 'Held' a little more water and all was well again.

So paying attention to swelling and dizziness, tell me if I'm off on my water balance.

[kristina]

Thank you Charlie B53, that is very instructive
and gives me a good idea what to look out for.
Fortunately my body is slowly beginning to get back to my "normal" weight
and hopefully I "only" have to get off another 2 and a half litres
from around my right ankle to be without water-retention ...
Thanks you again from Kristina.

[Darthvadar]

Kristina, my mum's Neph. told me that a good guide to keeping fluid levels balanced was to allow one litre per day plus whatever amount of urine Mum produced... He suggested that I measure her output... Well, there was the small matter of her being urinary incontinent, so go figure how much good a measuring jug would be!... So I came up with the idea of weighing the used Incontinence Pads (TMI, I know, but it's a reality of being a carer!)... I could then easily calculate her output, so her input could be decided on... She didn't seem to fluctuate much in her output, so after a while, I'd only weigh the used  erm, 'accessories' once a fortnight or so, just to be sure...

As Mum was producing so much fluid, she was often arriving at Haemodialysis as much as two kilos below her dry weight, they never took fluid off, just toxins... Then when she was a while on PD and was still often dehydrated, they reduced her exchanges from four to three... One yellow bag in the morning, one green in the afternoon, and one purple at night.... That worked well for ages, but then she started to show signs of dehydration again, they changed her green bag to a yellow... That worked REALLY well, and the dehydration was no longer much of an issue.... In fact, I'd often make her an extra cup of tea or two during the day if I thought she was getting a bit 'dry'...

Again, I suppose it's all down to the individual... Trial and error may be the only way you find out for sure what does and doesn't work well for you...

Best of luck with it all...

God bless...

Darth...

[Michael Murphy]

One of the advantages of being married is my wedding ring.  If it slips off easily I am not retaining fluid if it's a little harder to slip off I am retaining a little fluid. I usually check just prior to dialysis.

[kristina]

thank you Darthvadar and Michael Murphy for sharing your experiences.
Hopefully I shall have good luck with a good regular water-output for a long while to come...
I shall also make regular check-ups about my water-input and water-output...
It is interesting what you write about your weeding ring, becaue I have noticed the same with my rings:
Whenever my fingers are swollen there is some water retention and when the rings go on my fingers easily
the water retention has subsided is again. Sometimes, when I have been out for some hours,
my fingers have become swollen and I only get my rings off by washing my hands and using lots of soap
to get the rings off again...
Thanks again from Kristina.

[Jean]

this thread is really full of a lot of good info. I am so happy to have all the pros we have here to help us out. Personally, I have to sort of nag myself to drink ( not on D yet) But I do seriously worry about water retention. Mine does not show up so much in my ankles or fingers, but I worry about it being too much around my heart. Of course, my Dr. wants to keep the fluid off, but also does not want me to take " too many" water pills. However, I dont know how many is too many. So, it is kind of hit or miss. When you first start D, don't the techs figure it out for you or do you have to do it yourself?

[kristina]

Hello Jean,
I do hope you don't take too many water-pills? And I do hope very much
that you and your doctor sort out together how many water-pills would be too many
and how many will do you a good service. I can well imagine that it could be a bit tricky...
I wish you good luck to achieve this without any problems.
To answer your question:
When I first started dialysis the techs did not know me and I had never seen them before either...
and the only progress for us was to work together as a team and sort things out together as soon as possible.
I already knew my real dry-weight, because my real weight did never change since I was a teenager many years ago
(since my kidneys first failed and recovered again a bit) and my weight has only ever changed recently,
when I began to suffer from water-retention, which was not even that much visible
because I have always been and still am naturally very slim with a perfect weight.
My "putting on weight" due to water-retention really only looked as if I "had put on a little bit", but not too much.
But I knew that it was very wrong, because nothing in my healthy vegetarian diet could possible contribute to my new weight gain,
except water-retention building up and I knew instantly that my "new weight" was very wrong,
because I had not changed anything in my healthy vegetarian diet at all,
so my new weight-gain could logically only be water-retention and nothing else.
When I started with dialysis I knew exactly how much water had to be taken off,
but I did not want to achieve that water-loss too quickly in order to continue and use the bathroom for as long as possible.
Because of that, I went about the "water-take-off-whilst-on-dialysis" very slowly and hopefully it went alright.
Best wishes from Kristina.

[JW77]

Much depends on each individual. I had some urine output on dialysis from my last transplant until a major infection seemed to put a stop to the last little bit of it. The non functioning kidney is still in, so I get a few mls now and then, but nothing more.

[kristina]

Thank you JW77. I also have noticed that the output seems to be very individual and I also have realized at "my" centre,
that each dialyse-user is completely different from every one else. Many suffered originally from diabetes which made them eventually need dialysis,
others need dialysis due to a kidney disease or due to an accident or even life-style.
It is strange to see,how quickly one becomes familiar with many other dialysis-users in the centre
and it is also interesting to experience, how a group of complete strangers assists and helps each other
to "get things right" and to survive as best as is possible...
Thankis again from Kristina.

[PaulBC]

This is a question I plan to ask my daughter's nephrologists, but maybe someone here has direct experience.

What happens to your bladder after residual kidney function stops for a long time? For those receiving a transplant, you will want your bladder to start working soon after surgery. Is the bladder so resilient that it can restart right away? It seems like every other part of the body atrophies after disuse.

[noahvale]

*

[PaulBC]

Hope this helps. - NV

Thanks! Yes, it helps a lot. My daughter is 9, and still has significant urine output after several months of dialysis, but it's good to have a sense of what to expect when she does receive a transplant.

[okarol]

Jenna never stopped urinating after 3 years of hemo, so this was not an issue.
Now, on peritoneal for 16 months, she still makes plenty of urine.