Please post questions/answer here
I know this wasn’t the gist of the question, but it came up in real time just yesterday. St. Patrick’s Day is a day when many people imbibe. For the dialyzor who doesn’t or hardly urinates, what additonal effect, if any, does the consumption of alcohol have on his or her body?
Did I understand correctly, that on nocturnal txs one can basically drink all he wants as long as it is added to the goal as with nocturnal it can easily be pulled off?
How is it that there are no fluid restrictions with nocturnal (I’m speaking of between txs)? Isn’t that an erroneous statement-wouldn’t it be more correct to say that one has better fluid control? Because one can only drink what one can comfortably handle- it would depend on how much output one has. Are there other factors that would determine how much one can drink without getting too full?
I’ll pop in here due to the time difference. 
Dr. Agar was referring to nocturnal dialysis done 5-6 nights a week (minimum 4) when he said there was no fluid limit. If the treatment is only done 3x/week–which he did NOT recommend, then it would be important to be careful, particularly over the 2-day “weekend” (AKA “killer gap”). If you dialyze at night 4-6 nights/week, he said there were no fluid limits. Even on the off days. And he can come back and correct me if I’ve misstated that.
Um, he did reply after this same question was posed. Let’s use a little common sense here. One can’t drink AS MUCH as they want, but as much as they want. His slide said NOT TO DRINK TO EXCESS and that LITTLE OR NO FLUID RESTRICTIONS… He’s not suggesting one go out and chug and chug and chug, but what is comfortable.
I think he did mention that 2L was a normal amount of consumption of fluid. If you’re drinking more than 2L of fluid on a daily basis you may have a problem.
I think I drink a lot of fluid in a day but I don’t consume 2L, except on St. Paddy’s day trying to keep up with Rich!
I was referring to “over” the table, not “under”.
[QUOTE=Harvey_Wells;17454]I think he did mention that 2L was a normal amount of consumption of fluid. If you’re drinking more than 2L of fluid on a daily basis you may have a problem.
I think I drink a lot of fluid in a day but I don’t consume 2L, except on St. Paddy’s day trying to keep up with Rich! :)[/QUOTE]
My point is, I think it is misleading to say there is no fluid restriction. I am not referring to Prof. Agar in particular. Many have said there is no fluid restriction with SDD or nocturnal txs, but one with reduced or zero kidney function can only drink what one can comfortably handle. SDD or nocturnal is not going to give one more capacity to drink. Some could not begin to drink 1L/day while others may be able to drink 2L. Output matters and possibly anatomy as to how much one can drink before fluid is up to ones heart.
I don’t think anyone is arguing your point but merely fluid restriction on in-center therapy is restricted to 8-16 oz IIRC and on SDD or ND you’re not restricted to that or in essence ‘normal’ consumption whatever is ‘normal’ for you.
When someone talks about fluid restrictions or the lack of fluid restrictions my reference point is in-center = restricted more frequent dialysis (SDD or ND) = not restricted or normal consumption. Like Rich said a little common sense is required and IIRC I think Dr. Agar’s 2L remark basically made that point. Obviously the longer you dialyze the greater amount of fluid you can remove simply because of time but only up to a certain amount.
I don’t think many, if any are being misled here.
I don’t think a lot of dialyzors are going to consume more than 2L in their daily routine (that’s less than 6 beers or 6 12 oz beverages + a binder for each beer you drink)
I don’t think anyone is trying to be misleading. I just mean, I hear it said quite a few places that there is no fluid restriction with SDD and nocturnal txs. But I think that gives the wrong impression. There is more leeway to drink as it will not be long before one does a tx, get’s it off and can begin again. But that is not to say, one can drink like he did before he was on dialysis., which is the way most might take it. Nope, one can not just drink a glass or more of water or other beverage of choice like he did before kidneys went out when he feels like it. Drinking is free-er then 3x but still very limited compared to a person who does not have kidney problems. That’s why I would not use the term we have now, but would say something like there is more fluid control with SDD and nocturnal.
Dear all
Firstly, thank you for giving me the honour of trying to explain some dialysis ‘stuff’ to you. I have read some of the comments that have been made about what I said – or didn’t say – in the ‘webinar’ yesterday and though I don’t want to start an avalanche of correspondence with me by this response and submit this as a single and a not-for-discussion comment … by me, at least … it seems that some may have applied what (I think) I said a little too literally.
When a speaker gives a talk to any group made up of a number of very different individuals, he/she must try to make comments that are ‘general’. As such, any comments made or numbers or values that are used must apply broadly to the group ‘you’ and not to the individual ‘you’!
We are all different. We are different in shape, size, age, height, body architecture and metabolic need. A 40 kg 76 yr old female is NOT the same as a 140 kg 28 yr old man or, for that matter, even necessarily another 40 kg 76 yr old female.
We differ and our needs differ.
I think I said – though maybe I am mistaken and, if so, I meant to say – that the average person tends to drink somewhere between 1.5 and 2.0 L/day. That is what most average people find to be a comfortable intake – neither forcefully limiting nor excessively guzzling. That is not ‘a recommendation’ re the amount to drink … it is just ‘an observation’ regarding what most people tend to or do drink!
For most average people, 1.5 – 2.0 L/day is neither fluid restriction nor ‘chug, chug, chug’ – to paraphrase one respondent.
2L is, to a 50 kg person, equivalent to 4% body weight (a litre weighs a kilogram) but 2L is, to a 100 kg person, equivalent to 2% body weight. So, 2L is not the same amount for all … indeed it represents a very different volume ‘hit’ in those two examples.
Remember, also, that a 2 litre intake does not mean a 2 kg weight gain but somewhere less than that. Remember there are fluid losses (the so-called ‘insensible losses’) from skin, bowel and breathing … just look at your exhalation on a cold day for the amount of condensation water you lose at every breath. Other things matter too – the heat of the day, for example.
Please … please, try not to take what I said as gospel, as literal, as meaning YOU … applicable to you and only you as an individual. My comments were made as a ‘herd statement’ for the group as a whole. It seems to me that some respondents have interpreted what I said as meaning ‘for them’ specifically … and that may be being a little unfair to me, your presenter.
I cannot know your individual shape, size, age, height, body architecture and metabolic needs. Only your team can know what, for you, as an individual, might be regarded as a fair, reasonable and comfortable fluid intake. What is fair, reasonable and comfortable will vary, person to person. Whether you are young or old, small or large, have cardiovascular problems or dont … all of these may impact on what is a suitable or unsuitable intake for any one individual.
Again, I MUST emphasise, my comments were directed at the ‘average’ person … if such even exists.
I tried to make the point that the longer and more frequently one dialyses over a week, the closer your safe, comfortable and average fluid intake approaches the safe, comfortable and average intake of an average person with normal renal function and normal fluid control mechanisms. Again, this is usually somewhere around the 1.5 – 2.0 L/day for the average person.
I also made the point that frequent but short dialysis is different from frequent and long … and which matters most (time or frequency) in the greater scheme of things isnt really certain … but that both matter. One thing is certain … the less frequently and the fewer hours per run that a person dialyses, the more stringent must be the fluid restrictions.
But … the average very big and young person on dialysis can (likely) take – on an average – more fluid/day than a tiny elderly person. What you can take in, as an individual inside your particular body habitus (whatever that habitus might be) must fall back to an individual assessment – for you as the individual – and must be done by your medical team … for you!
John Agar
So the good doctor thinks of us as a “herd”. Now we finally find out that we’re just like cattle to those who are suppose to care for us!
Rich, I sure hope you’re joking. Dr. Agar didn’t mean that he thought of dialysis patients as a “herd.” He was meaning a group of people as compared to the individual…speaking of taking things literally.
Dr. Agar, I really appreciate your efforts to try to let those on this message board (and on the Webinar) know that the amount of fluid that they can safely drink without getting in trouble depends on a lot of variables. I think you explained that very well.
Prof. Agar,
Fabulous explanation…thank you for making this subject more clear! On a humorous note, I know what you mean when someone, or everyone, thinks a comment is directed right at them when one is merely speaking in general terms. Happens to me all the time.
Not asking a question since you asked for none, but just thinking about what you said here:
“I tried to make the point that the longer and more frequently one dialyses over a week, the closer your safe, comfortable and average fluid intake approaches the safe, comfortable and average intake of an average person with normal renal function and normal fluid control mechanisms. Again, this is usually somewhere around the 1.5 – 2.0 L/day for the average person.”
I am happy to say I am finally going nocturnal 6x in just a few more days and a big thanks to all who helped me get there! At that time, I will see for myself if, in my case, fluid intake improves over what I have been able to comfortably drink in between SDD txs.
To anyone else on nocturnal, after a time on SDD, first, I am wondering if you noticed the ability to increase your daily fluid intake?
Beth, JA knows my sense of humor (he laughed when we chatted). I’m sorry if I threw you for a loop. I didn’t mean to get anybody on edge. Perhaps I should have left my private joke with him private.
[QUOTE=Jane;17473]Prof. Agar,
To anyone else on nocturnal, after a time on SDD, first, I am wondering if you noticed the ability to increase your daily fluid intake?[/QUOTE]
I actually think I drink less because I’m not thirsty at all.