Oh! The maths....

[Tonyg]

I arrived for my normal session yesterday, took off all my outdoor wear, made sure no weight in my pockets and weighed in. 68.85 kilo, not bad, my dry weight is 68, so no cramps today! Anyway, along comes the nurse, not one that's 'done' me before, but been there all along, and looks at my chart, stands in what seemed like deep thought for a minute, and says, "so that's 1and a half kilos then"  what! Says I, how's that? Now I'm no Einstein, but 68.85 minus 68 always gonna equal 0.85 in my book.
Now am I missing some intricate calculation, or is math in Greek somehow different to English?
They don't learn 'em how they used to,.......

[Simon Dog]

68.85-68+.4=1.25

If you are using the standard 2008 series Fresenius machine, you have to add 400ml for the volume of the saline rinseback at the end.

I arrived for my normal session yesterday, took off all my outdoor wear, made sure no weight in my pockets and weighed in. 68.85 kilo, not bad, my dry weight is 68, so no cramps today! Anyway, along comes the nurse, not one that's 'done' me before, but been there all along, and looks at my chart, stands in what seemed like deep thought for a minute, and says, "so that's 1and a half kilos then"  what! Says I, how's that? Now I'm no Einstein, but 68.85 minus 68 always gonna equal 0.85 in my book.
Now am I missing some intricate calculation, or is math in Greek somehow different to English?
They don't learn 'em how they used to,.......

[Charlie B53]

My Fresenius Clinic adds .5 for the rinse back.

They also keep a calculator next to the scale for those that wish to do the math.

my dry weight is curruntly set at 102.0  I am still good as low as 101.2 so it doesn't bother me to weight out slightly under.  They tell me I am an easy take-off and some days the machine takes out more than they set it for.  With that much allowance built into my dry weight I don't have any problems, unless I seriously over intake my fluids and come in way more than my usual.

I don't go eat Chinese any longer.

[GA_DAWG]

It took a few flirtings with blackouts, and a couple of actual blackouts, before one of the techs whispered to me not to allow them to add for the rinse. She said my body gave up fluid so easily, it was not necessary. She is still the tech I go to for any questions I may have.

[Tonyg]

Aha! Thanks guys... Actually on the mew 6000 series fresenius machine, thats so much different from the 4008 it probably means more added, I'll ask next session.
Perhaps the only problem I have here in Cyprus is the language barrier, and that's my fault not theirs, I'm in their country, should learn more of the language.

[lulu836]

It took a few flirtings with blackouts, and a couple of actual blackouts, before one of the techs whispered to me not to allow them to add for the rinse. She said my body gave up fluid so easily, it was not necessary. She is still the tech I go to for any questions I may have.

It is my impression that the rinseback is returning fluid to you that still remains in the dialysis machine.  Yes/No?

[iolaire]

It took a few flirtings with blackouts, and a couple of actual blackouts, before one of the techs whispered to me not to allow them to add for the rinse. She said my body gave up fluid so easily, it was not necessary. She is still the tech I go to for any questions I may have.

It is my impression that the rinseback is returning fluid to you that still remains in the dialysis machine.  Yes/No?

Yes so they remove extra and then give it back.  So if you are borderline you will have less fluid then you should (before its returned).  I also feel that its common where they do not return all that they should.

Some machines abroad actually have sensors that determine the liquid in the blood so they don't need to do these guestimates.  Also others actually add extra liquid to the blood (in the machine) and remove it via the dialyzer to insure that there is good filtering... Versus my clinic (DaVita) that felt they had to remove at least 1 KG to filter correctly.

[Simon Dog]

Also others actually add extra liquid to the blood (in the machine) and remove it via the dialyzer to insure that there is good filtering...

You're describing hemodiafiltration, which is not generally used in the US - though I think DaVita had a trial program.

[iolaire]

Also others actually add extra liquid to the blood (in the machine) and remove it via the dialyzer to insure that there is good filtering...

You're describing hemodiafiltration, which is not generally used in the US - though I think DaVita had a trial program.

http://jasn.asnjournals.org/content/early/2013/02/13/ASN.2012080875.full
In this prospective, randomized clinical trial, we found that high-efficiency OL-HDF in patients with ESRD on hemodialysis was associated with a 30% reduction in all-cause mortality compared with conventional high-flux hemodialysis. This mortality reduction was related to a significant risk reduction for stroke and infectious mortality.

https://academic.oup.com/ndt/advance-article/doi/10.1093/ndt/gfx277/4432201
Conclusions
Our results do not support the notion that HDF provides superior patient survival. Further trials designed to test the effect of high-volume HDF (versus lower volume HDF versus HD) on clinical outcomes are needed to adequately inform clinical practices.

[Charlie B53]

Cliff notes PLEASE!

I think that the dry weight we have established I have an allowable 'range' so whenever the machine takes of those few 'extra' tenths, I still FEEL fine.  As long as I stay like this I should do well.

Mortality rates take into consideration all deaths, not just those that occur immediately during and after treatments.  A surprising number of patients have other medical issues contributing to their death.  I don't doubt that many of these issues may be possibly a result of long-term dialysis, but far more likely of a genetic error that did not express until the patient has started dialysis.

Humans have a great number of genetic 'errors.  Surprisingly, most animals do not.  There is a growing theory that humans were a 'developed' creature through genetic manipulation.  NOT yet perfected.

Perfecting the Dialysis machines so as to accurately detect the water content of the blood would be a great improvement for those that may have their dry weight set too low.  Whether this could prevent cramping from large take-offs?  Good question that needs more research.

[GA_DAWG]

It is just an obsrvation, but since I started dialysis, it has been my observation that those who tend to follow the rules about fluid gain and diet, and who attend nearly all of their sessions, have much better survival rate, with many having been there 20 years or more.