The dialysis happy place...removing the right amount of fluid

I have been a dialysis technician for over three decades working for a non-profit dialysis company in the great Northwest.

I lost one kidney to clear cell renal cancer a couple months ago. I had a lot of time to think while I was recovering and am now back to work full time. I want to use the time before I retire to help our patients do well during and after their treatments.

I have been frustated lately by the assessments of dry weights. I know we can do better. The machine is unfeeling and doesn’t care the effect it has on the patient, but I do.

What are the best practices in your center. How does your target weight change? I am looking for a better way to figure the right amount to pull. It is the happiest place in the dialysis world. Any help would be greatly appreciated

I am a consultant with Medical Education Institute (MEI) and a long-time social worker. MEI has been very concerned about dialysis clinic practices where staff and patients are unaware of the dangers of removing too much fluid in a dialysis session that doesn’t allow enough time to remove fluid safely. Research has shown that taking off too much too fast causes organ stunning and increases patients’ risk of death, loss of residual kidney function, and increases symptoms patients feel during and after dialysis. Dr. Jennifer Flythe has published 18 evidence-based articles about the risks associated with ultrafiltration rates >10 ml/kg/hr. You can find those articles on PubMed by searching for “Flythe ultrafiltration.”

Home Dialysis Central that MEI administers has blogs on multiple topics, including this one. You can search the KidneyViews blogs for “ultrafiltration” and you’ll find 53 blogs that include that ultrafiltration in the blog. Dr. John Agar, an internationally known nephrologist from Australia, has written KidneyViews blogs on this topic so you can search for his name to read those blogs. They’re about multiple topics including ultrafiltration.

Finally, MEI developed an ultrafiltration calculator to help dialysis staff and home dialysis patients assess whether they’re trying to remove too much fluid too quickly. It uses the colors of a traffic light to show what’s safe and what’s not. You can find the calculator and a video that explains where water is in the body and how dialysis can only remove water from one “space.” You might want to encourage your staff and patients to watch it and check out the calculator.

Thanks Beth. I enjoyed learning about ultrafiltration and viewing the blogs by Dr. Agar and others who have thought deeply about this subject. I spent hours going from one to the next. Thanks for all you do at MEI and Home Dialysis Central to ease the burden of patients and educate our frontline providers doing the best they can. You are making a difference.

Thank you! We try to meet patients’ and providers’ needs.