Very informative web conference. Thank you again Prof. Agar. Most everyone on SDD and nocturnal dialysis say they can drink more liberally, but can they? With nocturnal it is shown that one can remove a more liberal fluid goal without complications, but the question is, how much fluid can/should one consume/carry between txs so as to not damage organs? Some patients say they can comfortably consume/carry a great deal more fluid than others- is there a set rule on maximum fluid consumption or does it vary by person? And is it permissable to guzzle one last drink or two right before a tx since the fluid will only be in ones system for a short time before being removed?
Hi Jane,
I’m not Dr. Agar, but I did ask him the “can you drink a 1 liter beverage on dialysis (or just before) and expect that the treatment will remove it?” His answer was that the fluid has to be absorbed in the stomach and gut, before it can get to the bloodstream. Only fluid that is in the bloodstream can be removed by dialysis.
I tried to look up how long it takes for fluids to be absorbed through the stomach and into the bloodstream, but wasn’t able to find it. The problem is, to the extent that you add a large amount of new fluid to your body just before dialysis, the treatment will be less efficient at getting at the fluid that that is inside and between cells, because this has to happen through capillary refill. Each “compartment” has to equilibrate. So, as you pull water out of the blood through dialysis, water is slowly (over several hours) pulled out of the cells and between the cells and into the blood. When your treatment lasts longer than several hours (as in nocturnal), this works great. With shorter treatments, there just isn’t time to get to the fluid in your tissues (in cells & between them), so it stays put.
YES, people on nocturnal can drink more. Theoretically (and Dr. Agar can pop in and correct me on this if I’m wrong), they should be able to drink anywhere up to that 350-400mL per hour that is the average “limiting rate” for fluid removal x 8 hours of treatment. So, up to 3200 mL (3.2 liters) could be removed comfortably, with no drop in blood pressure, and without “stretching” the heart as he says. If you do nocturnal 6 nights a week, that means you would likely be able to take in more fluid than you would even WANT to. But you don’t have to, of course.
I was watching last night and thought it was so informative. I have a number of people I want to view it when it is archieved. I am also going to tell our center about it so they can pass it on to “folks” who over indulge and then blame the nurses/techs for taking them to dry weight.
Pat
After the session I had a quick chat with Dr Agar and he had mentioned that thier were a number of questions that he seen out of the corner of his eye…questions that are answered in the FAQ
s section at his site… www.nocturnaldialysis.org… if you have other questions on last evenings session or Part 1 I’m certain that John would be more than happy to answer them for you.
And yes last nights session was very informative and I also firmly believe that the more hands these sessions get into the better
Hi y’all,
Since Dr. Agar said we could post this, here you go! 
If you click on it, it gets bigger. IMHO, he is awfully up close and personal with that fish. I mean, I love fish, but really… 
[QUOTE=Dori Schatell;16354]Hi Jane,
I’m not Dr. Agar, but I did ask him the “can you drink a 1 liter beverage on dialysis (or just before) and expect that the treatment will remove it?” His answer was that the fluid has to be absorbed in the stomach and gut, before it can get to the bloodstream. Only fluid that is in the bloodstream can be removed by dialysis.
I tried to look up how long it takes for fluids to be absorbed through the stomach and into the bloodstream, but wasn’t able to find it. The problem is, to the extent that you add a large amount of new fluid to your body just before dialysis, the treatment will be less efficient at getting at the fluid that that is inside and between cells, because this has to happen through capillary refill. Each “compartment” has to equilibrate. So, as you pull water out of the blood through dialysis, water is slowly (over several hours) pulled out of the cells and between the cells and into the blood. When your treatment lasts longer than several hours (as in nocturnal), this works great. With shorter treatments, there just isn’t time to get to the fluid in your tissues (in cells & between them), so it stays put.
YES, people on nocturnal can drink more. Theoretically (and Dr. Agar can pop in and correct me on this if I’m wrong), they should be able to drink anywhere up to that 350-400mL per hour that is the average “limiting rate” for fluid removal x 8 hours of treatment. So, up to 3200 mL (3.2 liters) could be removed comfortably, with no drop in blood pressure, and without “stretching” the heart as he says. If you do nocturnal 6 nights a week, that means you would likely be able to take in more fluid than you would even WANT to. But you don’t have to, of course.[/QUOTE]
I have always had one or two 6 oz drinks on tx and it pulls it right off with no problems, so it doesn’t seem to be true in my case that the tx will not remove it. Also, I try to drink until I am satisfied right before txs as I have just had supper and am usually still desirous of more to drink. I add it into my goal, and again, it is removed by the tx.
Although I am not a big fluid gainer, on occasion after a weekend of 3x, 4 hr txs I had removed as much as 3.5 with no symptoms. I know of others who routinely remove way more than that on in-center txs. But my question is more in terms of how much fluid is safe for a patient to gain and hold inside inbetween txs. without damaging organs?
Jane, if you have 1.5 liters of extra fluid in your body and you drink another .5 liters before dialysis (for a total of 2), you can pull off 2 liters. But instead of pulling off the 1.5 you had and perhaps some out of the tissues, you would only be getting at the 1.5 you had plus the .5 you added. Your tissues would still not get “dry” enough. I think I recall you saying something about being able to breathe more deeply now that you’re getting more dialysis. NOT being able to breathe deeply means you had too much fluid in your lungs before.
As far as how much to not damage your organs, I’m not aware that anyone knows, or that it’s a set amount that would be the same for everyone. As they say, your mileage will vary. People’s tolerance for too much or too little fluid in the body can vary quite a bit.
The important thing to keep in mind is that the body is built for homeostasis–a constant internal environment. It’s the extremes–the highs and the lows–that are a problem for your organs. If your blood pressure drops, your organs don’t get enough blood (and your access is at risk for clotting). If you are so fluid overloaded that you can’t breathe, you’re at greater risk for heart damage and pneumonia.
Sorry I was at work when this webinar was on but caught most of it last night. Dori you always look so sweet and calm even under the pressure of getting it all to work. I noted Rich didn’t like people chatting too much but I reckon that makes the whole thing more appealing and interesting. Especially when there are folks there that you know through postings on HDC and Aus Dialysis Buddies.
Congrats to all those involved and for the Prof giving of his valuable time. I hope that fish lived to tell the tale after you kissed it :0)
Hi Melissa,
We missed you! And we have a few words for the folks who put that site together. Rich had a great idea–set up a practice session with them so we can walk them through what’s been challenging for us. He and I have talked about the typing thing. It can be distracting for the speaker, but I think it’s important for folks to be able to interact, and the speaker can cover up that little window with a little card and rely on the moderator to pass questions along. 
We’ll have to see if Dr. Agar will tell us the fate of the fish. I suspect it was dinner!
Like I said — the fish is better looking than the Doc!
Yep, I do think there is a bit too much cross-chatting. It’s not that I don’t want people to interact. It’s that I do want people to interact that I want the ‘silly’ typing held to a minimum. As more and more people join in the webinars it’s going to be almost impossible to keep up with ‘real questions’. The screen was scrolling up so fast as everybody typed, that it was hard to separate the ‘wheat from the chaff’. What I mean is that the real questions to Dr. Agar were overwhelmed by other typing that he, nor Dori, got a chance to see them. Poor Arnie typed in a rather long (and serious) question twice and it was overlooked both times. Let’s remember the main purpose of the webinars is education. We shouldn’t be acting like little kids flinging paper airplanes across the room, or just passing notes, like we perhaps did in grade and high school. Besides, I think it’s disrespectful to the person who has agreed to give of themselves for people like us to learn. I would presume that if we were actually in a live seminar we would act more politely.
I agree with Rich wholeheartedly on this one. I have found it hard to concentrate on the speakers, because I am trying to read the questions/comments that are coming in with a barrage of social type comments that are totally unnecessary. And the chat is bouncing all over the place so is not even readable. I also typed some questions that must of flipped out into cyberspace as they never posted. I missed parts of the presentation due to the many competing voices. So, I’ll be going back to listen to a rerun when I can find the time, but would of preferred not to have had to do that. I do agree that interaction is very important, but there has to be a better way to achieve it without all the chaos. I’m sure as time goes on, we will work as a group to figure out ways to achieve smoother presentations that integrate patient participation. I’ve participated in a number of tele meetings and webcasts by various groups and they all have had similar problems. I’m always glad I learned something new, but always leave with a big headache. We’ll get there…
[QUOTE=Dori Schatell;16363]Jane, if you have 1.5 liters of extra fluid in your body and you drink another .5 liters before dialysis (for a total of 2), you can pull off 2 liters. But instead of pulling off the 1.5 you had and perhaps some out of the tissues, you would only be getting at the 1.5 you had plus the .5 you added. Your tissues would still not get “dry” enough. I think I recall you saying something about being able to breathe more deeply now that you’re getting more dialysis. NOT being able to breathe deeply means you had too much fluid in your lungs before.
As far as how much to not damage your organs, I’m not aware that anyone knows, or that it’s a set amount that would be the same for everyone. As they say, your mileage will vary. People’s tolerance for too much or too little fluid in the body can vary quite a bit.
The important thing to keep in mind is that the body is built for homeostasis–a constant internal environment. It’s the extremes–the highs and the lows–that are a problem for your organs. If your blood pressure drops, your organs don’t get enough blood (and your access is at risk for clotting). If you are so fluid overloaded that you can’t breathe, you’re at greater risk for heart damage and pneumonia.[/QUOTE]
Dori, I see what you are saying here, but if I am understanding you correctly, I don’t think it’s correct. If I set my fluid goal for 1.5 liters after carefully assessing what I drank, that’s all I’m getting off- no more is going to release- at least not on any of the txs I have been on ( 3x 4 hr txs and SDD txs of about 2hrs 15 min.average). It might be different when it comes to nocturnal txs, and this is what I have been wondering about, but I wouldn’t know since I haven’t experienced nocturnal txs yet.
It was not me that said I can breath more deeply now that I’m getting more dialysis. I do breathe better because every day, except the day off on a 6 txs/wk, schedule, is a fresh chance to breathe freely again since fluid is removed 6x. But with 6x txs, I now have less output and get full faster. Eventhough my fluid goal is much lower than it was on 3x txs, I feel full to the brim by the time the next daily tx rolls around. The good thing is, the discomfort doesn’t last long- I do a tx and I have a fresh start again.
The best tx I ever had on dialysis bar none was the time I was critlined. It was like I was able to breathe in 3 levels deeper. I had forgotten what that felt like and it was glorius! Remember, as I said, I am not a fluid overloader -I probably have some of the lowest fluid gains in my clinic. I feel better now than I ever have on SDD, but I still question if there is fluid aboard that txs are not getting off and wonder if nocturnal, with it’s longer length of time, can get to that fluid. I would love to be able to compare if nocturnal works something like critlining.
Re how much fluid one should be able to hold inbetween txs without damaging organs, a professional told me once that no matter how sizeable a patient is, the vascular system ( think that is the correct term) can only safely hold 2.0. I do not know if this answer is correct. Just mentioning it here for the sake of this discussion. If someone can say otherwise, I would like to hear it. Maybe I can find more info on this subject through contacting the professional again and post it at a later date. I asked the professional well then how do some patients consume so much fluid and the individual replied that it is affecting them, but they just don’t know it.
Anyway, fluid is one of my favorite subjects. I have good control and don’t overdo it, and since being on 6x txs have much fewer problems with thirst. But ever since my kidneys failed, fluid has become my mortal enemy- I would love to have more of it, but can’t go there lol! Every dialysis patient knows what I mean.