Dehyrdation-fluid full time

So they have decided I am dehydrated again using only 1.5 solution. My nurse suggested that instead of doing a manual drain in the morning to get rid of the 2100mg, to leave it there so i can absorb some. Allowing me to absorb in hopes of not getting dehydrated. I think this is a terrible idea for 2 reasons. Being awake and having 2100mg moving around, going to the store, etc, is very uncomfortable. and 2. the only time I really eat is when my belly is empty of fluid because it fills it up so much… Do you think its a good idea to leave the solution in until I hook back up at 5pm? Absorbing fluid that has pulled off toxins and so forth…wouldnt that be a bad thing as well? So that would mean going back to having fluid 24 hours a day. I thought PD was supposed to be more ideal…sure isnt sounding more ideal to me right now!

Also forgot to mention that I have been on PD starting Oct 2011. Have had a lot of issues with adequacy and my current adequcy is 1.73. I currently hook up at 5pm and fill 1800ml. Hook back up at 8-9pm to drain and start my nightly dialysis of 4 fills at 1:43 a dwell. Then after my final drain, the machine fills me with 2100ml that I will drain when I wake up at 9-10AM. That is my current schedule but I am becoming dehyrated. I was hosptialized for several days last month because of low sodium and feel i am running out of options on PD!! Any suggestions would be greatly appreacited. Thanks :slight_smile:

Also my abumin has been 1.8-2.5 for over a year. I don’t have the appetite because so much fluid in. I usually eat one meal a day around 2-3pm. And if I am lucky can squeeze in another small one…

not sure how to delete a post but tired of checking this everyday with no response…so please delete and I will go elsewhere

I apologize for not replying to your post but I have been out of the country since August 29th. Perhaps you will not read this since you said you were going elsewhere, so please let me know if you have read this reply and then I will try to answer some of your questions about PD.
Judy Bernardini

I am still here and would love to hear any suggestions you might have.

Dear Aimsgirl16,
You need to help me understand your prescription a little more completely. If I understand correctly, you are on the cycler each night for 4 exchanges of 2.1 liters each, correct? and then in the morning, the last fill of the cycler is 1.8 liters which you manually drain around 8 or 9am when you wake up. Then at 5pm you have another exchange of 1.8 liters which dwells until about 8 or 9 pm when you go back on the cycler, and all your bags are 1.5% dextrose. So make sure this is what you are currently prescribed. And your KtV is 1.73. I need to know a little more----about how much urine do you make each day? Do you know what your GFR is? (a measure of kidney function) If so, tell me that as well. And I presume you had a PET last year when you began PD, so it would be very helpful if I knew that. Also, how much fluid do you ultrafilter most days? How much do you drink each day? And finally, are you on a diuretic medication like lasix? and what is your body weight?
I am very concerned about your low albumin and the fact that you are eat only one meal each day. And I am concerned that you are dehydrated as that will effect your residual kidney function in a negative way in addition to making you feel lousy. So if you can try to send me as much of the information I have asked you about above, I may be able to help you understand some of your options to make PD work better for you and give you a better quality of life. I want you to feel well on PD.
Looking forward to hearing from you again, Judy Bernardini

Yes, that is my prescription. I make about 150-300 ML each day of urine. I drink about 2or3 32oz of water. MY UF’s run 600-1000L. My last GFR fluctuates all the time. Sometimes my creatinine will be down in the 7’s and the next month it is in the 13’s or higher. I did have a pet at the beginning of this year and I was deemed a slow transporter and my dry body weight is 230 (gained a lot on heavy doses of prednisone trying to save the kidney) I am not taking any lasiks.

As far as the albumin…I will recieve my first shipment of IPN on Tuesday. So hopefully that will bring it up and they have put me on marinal to increase my appetite. And that is working as well!!! Thanks for getting back to me!!!

Dear aimsgirl16,
My first concern is your fluid intake, which is about 2-3 liters per day. But you only put out about 1 liter per day (urine plus UF). So that is likely to cause you to have high blood pressure and swollen ankles, legs, hands or face. Your UF is perfectly normal and I suspect that your GFR (the calculation of kidney function from 24 hour collection) is about 4-5mL/min. It is very important to protect that function as it will always help you clear toxins and fluid. Being dehydrated is not good for that kidney function nor is high blood pressure.
I am curious about the cause of your kidney disease as some diseases cause the kidneys to dump sodium and perhaps this is the problem. You need to talk with your PD nurse and nephrologist to ask about this. You said you were on high dose prednisone—are you still on that? because that would actually cause you to retain sodium.
As for your prescription, you said you were a low transporter which means you clear toxins slowly across the peritoneal membrane so your exchanges should all be longer, such as only 3 night time cycler exchanges to give longer dwells and a long daytime dwell. Again you need to discuss this with your PD nurse and nephrologist.
Hope this helps, and keep in touch if you have more questions.
Judy Bernardini

Hi there! Thank you for the help. I actually have a 2 three hour day time dwells and a 4 night dwells at 1:44. This keeps my adequacy right at 1.7ish. The original cause of the kidney failure is Lupus and I am no longer on high dose steriods. Down to 1.5mg and going to be off in a few months :)! And suprisingly, no signs of edema anywhere. Occasonly I will have swollen eyes in the morning but always goes down as the day progresses.

I was doing a long day time dwell, for about 8 hours but started to retain fluid doing that and was having other issues. SO they took the 8 hour dwell and split it in half and seems to work for the most part. I have an adeqacy coming up and we will find out how that does. My nephrologist told me I am one of the lucky few that can eat sodium so I have been put on a high sodium diet and seems to be working with the dehydration to!!!

If your day dwell before was only 8 hours, how long is your cycler treatment? And I also gather that you had difficulty eating when you are dwelling so that you want to be empty in order to eat. Even though your KtV is adequate now, your prescription still might be better for your overall health if you extend the exchanges. So perhaps you could drain the last fill of cycler just before your midday meal and then fill again soon after to give you 4 to 6 hour dwells which is what a low transporter needs.
Glad to hear that increasing your sodium intake in your diet is helping with dehydration. take care,