Cramp or crash on SDD/SND

Is it less likely to have a cramp or crash on SDD/SND than 3x incenter dialysis? If so, have you eliminated the possibility completely or has it still happened to you? What steps do you take to avoid?

Some causes of the C/C syndrome are high gains, short time to remove fluid, removing fluid less often, gaining or losing real weight and incorrect dry weight/goal. So how do daily txs change the picture?

If it is possible to have a cramp while dialyzing in bed, how do you deal with it?

Much less likely on either SDD or SND I would’ve thought. I used to get horrendous cramping when I was on P.D. :shock: But since H.D., it’s vastly reduced. FLuid/weight gains will be less for both of us types - Gus (& other Nxers) is dialysing nearly every day, so will have less fluid because it’s less than 24 hours between coming off/going on; I will have more fluid, but am taking a lot longer to take it off, so the body adjusts, doing 3 sessions @ 9 & 1 @ 6hours per week. The poor old 3x5s in center will have the same sort of fluid gain as me on their alt days…a lot more on their 2 day gap…and are taking it off @ 700ml+ per hour!!! :frowning:
Btw my average is 3.3liters…we have a ‘max’ rate of 400mls per hour on nocturnal, altho I’ll go over that a bit on my ‘awake’ session on Sunday evenings, if I think I need to take more off. So a typical night is 9hours @ 375-400.

It’s pretty hard to get cramping when you’re only removing 400 or less ml per hour, unless you are seriously drying yourself out too much. I’ve had very minor cramps on short daily when removing 1000 or more ml/hour, but never on nocturnal.
Pierre

Gus wrote:

Daily-Short keeps a marginal line without harsh drops/increases of wellbeeing…whilst in-center there’s harsh drops/increases on vitals and symptoms…

Well let me ask, has anyone cramped or crashed on SDD or on SND? Say you have challenged your dry weight by .1 each tx and one day you have gotten too close- is the feeling that a cramp is approaching easier to discern and adjust for than with 3x incenter dialysis? Is your first line to back off the goal gradually or do you go for the saline?

What if your were to cramp or crash at home- would you handle it any differently than you would in-center? Do you have a back up person in case you need assistance?

Nocturnal is designed so that you shouldnt crash. A UFR of 400ml/hr is supposed to prevent crashing. I have a major fear of crashing during my sleep, but I have been told that if anything is wrong YOU WILL WAKE UP.
If you are doing short daily and are running at a high UFR, then I cant see why there wouldnt be a chance of crashing.

  1. I wouldn’t count on waking up when BP is too low.

  2. Consequently to (1), there really isn’t any need to “challenge” dry weight all the time. Because BP is more normal on nocturnal, I only try to keep it above 120. Usually I’m increasing dry wt rather than decreasing it. I think that challenging for lower DW would be a little risky on nocturnal, and there’s no need for it anyway. As long as BP is neither too high or too low, and you’re not swelling, you’re Ok.

Pierre

Hi Pierre,
You are speaking about nocturnal, but what about with SDD?

Short daily is different in that the person doing it is presumed to be alert and keeping an eye on things, recording a round at fixed intervals. So, it’s not unlike in-centre hemo in that regard. You don’t have to have the same cautions as you do when you’re going to be on dialysis for 8 hours and you will be sleeping. So, it’s more possible to challenge dry weight more to see if you can get BP lower. But on the other hand, it would still be extremely dangerous to crash at home, and because most treatments on short daily would be removing a lot more than 400 ml/hour, there’s more chance of that happening.

This is why SOP in my program here is to check BP every 30 minutes when on short daily, log it, and infuse saline if systolic is under 110.

Pierre

Because short-daily helps keep fluids at bay the probability of crashing are low…for example, in my case 3x a week in-center I needed to remove 2.5 - 4.0 kg of fluid overload and with only 3 hours allowed on machine they were required to try to remove it all in one go! The end result was horrible…just horrible…and once I came home the first thing I would do is go to bed, all drained, weak, just horrible!

Now that I am on short-daily that in-center ordeal is gone…I feel better, more energy, more alert, blood pressure is normal, no more dragged drained symptoms, no saline needed, and only removing from .3 - 1.2 per day…the end results are much much improved than that of in-center…very BIG difference…

The only way a patient will crash on short-daily is when he/she is not managing their treatments correctly. Like I previously said, some patients try to remove much more than what is required and that’s when they will get sick and need saline. Careful management is the key to successful treatments, but really theirs no such thing as crashing on daily-short nor Noctirnal…its all dependent on how the patient is managing their treatments… :roll:

Gus, you said it yourself: managing fluids properly. I agree 100%. When on short daily, in order to have the low UF rates you’re talking about, you have to manage your fluids. There’s only one meaning to that: keeping fluid intake low, or simply put, limit fluids. But that’s kind of self-imposing something that should not really be necessary when going to the trouble of dialyzing daily. One thing most people will want is a much looser fluid restriction. Just being a little more vigilant about low BP when on treatment is all it takes. 24 hours is 24 hours no matter what kind of dialysis we do. Doing dialysis daily does not magically open up some special fluid compartment in the body which doesn’t show up at weigh-in.

No, its not like that…its all dependent on the patients prescription. For example, all of us on NxStage DO NOT do 2 hours a day…not even myself…currently, I am doing from 2.5 - 3.7 a day…but on an average daily basisc its only 2.5 - 2.7 …that’s my prescription. Now for someone who drinks ALOT more than I do then their prescription is differtent than mine, they may be dialyzing from 3.5 - 4. hours daily…as you can see time is beeing spread out evenly without relying on strict timing like in-center does, so that’s the beauty of having dialysis at home. Certainly, I am drinking more than what I did in-center… :slight_smile: Just like you have the option of dialyzing longer we also have the option of dialyzing longer than two hours…

Gus:

only removing from .3 - 1.2 per day…

What is the highest goal you have on SDD including fluid gain, p & r and drinks taken in on the tx?

Also, what is the lowest bp you go to before you decide your dw is low enough and not to challenge it further?

Now we’re back to the ongoing argument I’ve had with Bill. People in this forum use the term “short daily” pretty loosely. It’s not “short” daily when you get to around a 3 hr treatment. That’s conventional hemo done daily - and it represents an awful lot of time on dialysis every day. If NxStage requires longer treatments like that, I’m not sure I see where the advantage is. Two hours on dialysis every day is endurable, but longer than that seems like quite an ordeal to me.

Heather wrote:

What is the highest goal you have on SDD including fluid gain, p & r and drinks taken in on the tx?

Gus wrote:

On an average .8 only…that includes 6 oz V8 drink and some snacks …if I don’t drink on dialysis then its from .3-.5…missed days from .8 -

You have a very low goal. What were you told was the limit you could safely pull off per tx?

Pierre wrote:

Now we’re back to the ongoing argument I’ve had with Bill. People in this forum use the term “short daily” pretty loosely. It’s not “short” daily when you get to around a 3 hr treatment. That’s conventional hemo done daily - and it represents an awful lot of time on dialysis every day. If NxStage requires longer treatments like that, I’m not sure I see where the advantage is. Two hours on dialysis every day is endurable, but longer than that seems like quite an ordeal to me.

Are SDD txs. done on different model machines of different duration? I have heard where NxStage txs average about 2/12- 3 hrs depending on the patient’s size, blood pump speed and how much his fluid gain is. A larger fluid gain can add, 10-15 minutes or so to the tx. ON conventional model machines would the patient have to use a higher blood pump speed to run a 2 hr tx?

I too would agree that longer than 2 hrs a day becomes drawn out and is no bargain, unless one is doing nocturnal. It would be great to feel better, but if the txs cut into daytime hrs, that is a big loss of useable time.

For my needs that’s all I need, everyone is different and each patient has their own individualized prescription settings, so you have to be careful comparing me with the other NxStage users or any other patients, it doesn’t work like that. On the contrary, Pierre thinks Short-Daily is not gentle, but based on my own experience its is as I have felt the difference between conventional in-center 3x a week and daily-short. …with over 20 years on dialysis I think I have enough experience to feel what i feel… :slight_smile:

As far as the goal its all dependent on the patients needs…for example, If I need to take off 2.5 but I don’t gain 2.5 on an average basis then I don’t remove all of it, only 1/2 - 1/4 of it…though I can remove it all in one go its not worth it…as I will dialyze the next day…get it? its all spread out evenly…on the other hand if I gain 2.5 on an average daily basis then I’d decide to run for 3.5 -3.7 hours or more…

Heather says… :smiley:

I too would agree that longer than 2 hrs a day becomes drawn out and is no bargain, unless one is doing nocturnal. It would be great to feel better, but if the txs cut into daytime hrs, that is a big loss of useable time.

For some of you, but for a good bunch of us enjoy the evening hours dialyzing…for me between 4pm -11pm…that’s a great number of hours :wink:

Pierre wrote:

Doing dialysis daily does not magically open up some special fluid compartment in the body which doesn’t show up at weigh-in.

We heard that doing SDD one can get closer to one’s dry weight , because daily txs allow the tissues to release more fluid and because one is not pulling off as much fluid at a time, usually.

Abolutely, how I can I agree with you…its been spoken at my clinic and its been experienced. Daily-Short is quite beneficial on controlling fluid gains and keeping it at bay…one of the reasons it feels more gentle than in-center…