New Policy for amount of fluid taken at treatments- Fresenius

[kitkatz]

The nurse at dialysis talked to patients about the "New" formula used for taking off a safe amount of fluid given your weight and time on the machine.
I asked what the formulas was.
It is your weight in Kg times 13 (It has been shown that the maximum amount of fluid removal during dialysis should be less than 13 cc/kg/hr to avoid risk, but that even at 10cc/kg/hr heart failure symptoms start to develop) times your hours on dialysis. 
 
http://www.homedialysis.org/ufr-calculator
Home dialyzors have been using this calculator for over a year or so. 

It is now Fresenius policy to calculate the safe fluid removal rate using this calculation.

My calculation is 107 times 13 times 6= between 8 to 10 kilos.
The nurse was worried about my four kilos I have on regularly, turns out with my weight and time I could take 8 kilos off safely.  That would turn me into a puddle of goo on the floor.  We both giggled at the 8 number.  I think she was surprised at the calculation.  I asked her what the 13 in the calculation was for and she did not know, so I looked it up on my phone after dialysis.  I will tell her when I see her again.

[cattlekid]

 

That would have been me.  My calculations would have been up to 5 kilos for my four-hour in center treatments.  I always told my in-center nurses not to take off more than 2.5 kilos at a time or they would be cleaning up a mess they didn't want.  I would have rather left with a half kilo extra on (I still had plenty of residual urine function) than been cramping and puking everywhere.

What a bunch of morons.

[Simon Dog]

It has been shown that the maximum amount of fluid removal during dialysis should be less than 13 cc/kg/hr to avoid risk, but that even at 10cc/kg/hr heart failure symptoms start to develop) times your hours on dialysis. 

Holy department of redundancy department department.

[Charlie B53]

My dry weight is currently 102 K.  If I am 3 or more over I will break out in a sweat then cramp both calves.

This 'formula' is insane!

[Michael Murphy]

Charlie it’s possible your dry weight is too low. 

[Paul]

It is your weight in Kg times 13 (It has been shown that the maximum amount of fluid removal during dialysis should be less than 13 cc/kg/hr to avoid risk, but that even at 10cc/kg/hr heart failure symptoms start to develop) times your hours on dialysis.

In the UK Fresenius still use 10cl per kg, however I don't think they told the nurses. When I started I was 92kg dry and they were taking off 4 litres per 4 hour session. About a month in the doctor visited during a session and told them to extend my session to 4 1/2 hours. Since then I've put on a bit of weight, but not yet made the magic 100KG dry that would allow me to go down to a four hour session.

My dry weight is currently 102 K.  If I am 3 or more over I will break out in a sweat then cramp both calves.

Charlie it’s possible your dry weight is too low.

What causes cramps varies from person to person, that formula is for what is SAFE for the heart (or safe-ish) not what causes cramp, that could be dry weight too low, drawing too fast, or just the way you are made. The  sweats are more likely to be too low blood pressure (but could be something else).

[Charlie B53]

Charlie it’s possible your dry weight is too low.

I've weighed out as low as 101.2 and been fine, then again I've weighed out at 101.1 and cramped every time I lay down and sleep for the next 18 hours.   102 I'm fine but my residual kidney function slows, a LOT.  I produce far more when at 103 or above.

Dry Weight is a PITA.  Clinic staff wants to pull us as low as possible.  I don't necessarily agreed.  I think as long as we have no negative effects, like swelling, pooling in the lungs, around the heart. we should try to keep an average weight well into our 'comfort' zone.

Surprising how much just one K difference can make.

[Michael Murphy]

Problem the patients generally are alive, and as living organisms our weight fluctuates for a host of reasons.  I haven’t worked the math out but I think this calculator is a way to approximate dry weight.  If you suddenly feel crappy have the ultra filtration shutoff.  Take the fluid you have removed enter it into the calculator with your weight at start and your session length run the calculator if it does not end in the green remove part of the fluid say 3 liters to 2.5 keep adjusting the removal number till you end up in the green.
Subtract the final removal number that ran green and subtract that number from your starting weight.  I  propose that the final subtraction would be your dry weight.  Next time I go to the nephrologist I will run it by him.

[Paul]

We have a "thing" in our clinic that works it out. It looks a bit like an ECG machine, the nurse types in your height, sticks electrodes to a wrist and foot, and the machine runs an electric current through you. It then tells the nurse what your dry weight should be. I have no idea how it works, all I know about it is that we have to take our mobile 'phones out of our pockets otherwise the machine damages them. It seems pretty accurate to me.

[cassandra]

We have a "thing" in our clinic that works it out. It looks a bit like an ECG machine, the nurse types in your height, sticks electrodes to a wrist and foot, and the machine runs an electric current through you. It then tells the nurse what your dry weight should be. I have no idea how it works, all I know about it is that we have to take our mobile 'phones out of our pockets otherwise the machine damages them. It seems pretty accurate to me.

Wow!!!

[kristina]

We have a "thing" in our clinic that works it out. It looks a bit like an ECG machine, the nurse types in your height, sticks electrodes to a wrist and foot, and the machine runs an electric current through you. It then tells the nurse what your dry weight should be. I have no idea how it works, all I know about it is that we have to take our mobile 'phones out of our pockets otherwise the machine damages them. It seems pretty accurate to me.

Wow!!! ... and ... Hello Paul!
Please tell me: How is this "thing" called and how often is it used on each patient? And how often has it been used on you?
Of course, I am dying to find out where this machine is placed but I do respect our privacy and won't ask more ...
Thanks for the information about how this magic machine is called and kind regards from Kristina.

[Rerun]

They need to figure out blood pressure also.  If mine goes below 80 they have to shut me off.  I hope to get off 2 liters in 8 hours but it doesn't always happen because of my blood pressure.

[Charlie B53]

As a Retired Marine Mechanic/Machinist/Electrician I am fascinated by  all things mechanical/electrical and would LOVE to get my hands on this machine to see how it works.

Since electrical leads are attached to a wrist and an ankle I imagine it really is much like a glorified Ohms Meter measuring the electrical resistance through the length of the body.  Higher water content would measure less resistance.

This 'could' work for the 'average' person however allowance must be made for height, body 'build', and obesity as total body mass could easily skew the number measured.   All in all,, still a pretty cool machine.

[Paul]

As a Retired Marine Mechanic/Machinist/Electrician I am fascinated by  all things mechanical/electrical and would LOVE to get my hands on this machine to see how it works.

Since it is about the same size and shape as an ECG and the electrodes are the same type as used by an ECG I'm guessing they use similar technology, but that is a guess, I have no real evidence of this and may be miles off (after all my latest scanner/printer is about the size and shape of a large loaf of bread, and they work in entirely different ways).

allowance must be made for height, body 'build', and obesity as total body mass could easily skew the number measured.

Sorry, I did mention that they type the patient's height into the machine, I forgot, until I read your post, that they also weighed me and typed my weight into the thing as well. "Obesity" is a measure of mass against height, so it would not need this as a separate input since it already has height and weight.

Please tell me: How is this "thing" called and how often is it used on each patient? And how often has it been used on you?

I have no idea what it is called, I'll ask the nurses for more information on Monday if I remember, but there is a good chance they are just told how to use it, and know no more than that. I think it is used every six months, it has been used on me twice, and I have been at that clinic about nine months (the hospital I dialysed at before then did not have a "thing").

Of course, I am dying to find out where this machine is placed

If you mean "Where it is placed in the room?": It is portable and moved next to the bed on which the patient is lying (mostly it is used in the doctor's side room, but it can be used in the dialysis clinic while being dialysed if that is the only time the patient can spare). If you mean "Where is it placed on the patient?": One electrode on the wrist, one electrode on the ankle.

They need to figure out blood pressure also.  If mine goes below 80 they have to shut me off.  I hope to get off 2 liters in 8 hours but it doesn't always happen because of my blood pressure.

That is nothing to do with the maximum amount they can take, nor your dry weight measurement, it is on a session by session basis and depends on how your body reacts on that day. It also depends on how good the nurses/technicians are at regularly checking your blood pressure. There have been times when I have known from the way I feel that blood pressure is too low, but I have kept quiet because I am overloaded and need a full 4 litres that session. Only occasionally have I been caught by a nurse.

[GA_DAWG]

For a time, we had this thing that looked like a Pong video game that was supposed to tell them if they were removing too much fluid. I guess enough people passed out they decided it didn't work as well as advertised. Next thing I knew, there were signs on the machines saying out of order.

[Paul]

For a time, we had this thing that looked like a Pong video game

Convert it into an actual Pong video game, hold matches during dialysis!

(Or use it to teach the young 'uns what video games used to look like!)

[Paul]

Please tell me: How is this "thing" called?

I'll ask the nurses for more information on Monday if I remember.

Took me a while to find a nurse who actually knew the answer, and by then my computer was not working. But I have the info now. It is called a multiple frequency bioimpedance body composition monitor (not the same as a standard body composition monitor, which is something you use to loose weight/get fit). Here are a couple of YouTube links to videos about the machine:

The first one is a more basic machine than the one they use on me, but it gives the most info:
https://www.youtube.com/watch?v=vTcUS3qCLSU

The second video is the version they use at my clinic, but this video gives less information, which is a bit frightening as it is a Fresenius staff training video!!! (It also looks like an old 1970's British public information film, but it cannot be, however that makes it funny to watch if you grew up on those things.):
https://www.youtube.com/watch?v=WnPXyrzh5rU


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[Michael Murphy]

The nurses at my clinic surprised me and knew the new limit.  I would also point out the Fresenius portal says the maximum I can remove is 5.8 though I generally stop at 4 if I feel CHF symptoms.

[Charlie B53]

And I think I am really really bad when ever I come in at 3 over, I want to kick myself in the back side.  I haven't been 4 over, yet.

I don't even want to think of 5.8 or more.  Just the mere thought is enough to keep me scared DRY.

I so much miss pigging out on Clam Chowder, Split Pea Soup, very wet beef stew, and so many many more wet foods that I now severely limit, not to mention NOT gulping down a huge glass of just plain ice water on a hot day.

About the only good thing is I am slowly losing some of the weight that I have been carrying around for far too many years.  My jeans fit again!  Maybe, just maybe, my motorcycle will be faster too!

[Michael Murphy]

My problem was not too much fluid but I occasionally have periods where my weight drops, if that happens and they use my dry weight to remove fluid as I loose weight I have more and more fluid build up.  When I was removing 4 kilos a treatment for 4 treatments my blood pressure never dropped during Dialysys.