Weight shifting?

My husband’s weight usually is lower than he is worked for when he comes off dialysis. When we were at the center they used to tell him that his weight had shifted - from his blood to his cells I think and it would weigh less. He used to always question it by saying if the fluid was there it should weigh the same no matter where it is. When we went for training the same thing happened and he told them what he had been told at the center about it moving to the cells. They had never heard of it and were of the same opinion as him that if it is in your body it has to weigh the same. It is still happening at home. There are mornings he has come out 600 under even after drinking fluid that wasn’t adding in to his goal. Any ideas why this is happening. He tries to compensate by drinking fluid that is not added to his goal.

Hi Delphine
I am on a Fresenius (I don’t know what your husband is on) and do Nocturnal. If I do a short run I have to allow 400ml for the saline in lines but on Nocturnal I don’t take the 400ml extra off, I weigh myself before an evening meal (as I am on 2 hours after) and I still usually come off 200ml light. Therefore I lose around 600ml during my “sleep” due to expiration etc and a trip to the toilet in the morning when I come off before I weigh myself again.
Hope that helps.

Accuracy of scales??? Most scales are not all that accurate and even weighing three times sometimes is not enough. I am in the process of trying to find a more accurate scale then the one I have at home. I have this same problem sometimes, but it doesn’t seem to make much of a difference for me. I keep a little extra fluid on me for my digestive tract to work properly.

[quote=delphine;11468] …
When we were at the center they used to tell him that his weight had shifted - from his blood to his cells I think and it would weigh less. He used to always question it by saying if the fluid was there it should weigh the same no matter where it is. …[/quote]

I agree with your husband water weighs the same. There are three internal fluid “compartments” in the body: the vascular system - veins and arteries; the space inbetween the cells - intercellular space; and inside the cells themselves. During dialysis as fluid is drawn from the vascular system, fluid from the adjoining spaces migrates into the vascular space so as to maintain equilibrium. In that sense the first unit was correct – water is migrating among the three compartments - from the cell compartment to the vascular system – but this would not cause a “weight shift”.

It could be a scale malfunction but one would not expect the malfunction to always be the same. Since this has happened both incenter and at home then I would guess that your husband simply gives up fluid easily. Perhaps he does a great job controlling sodium or it could just be the way he rolls. The machines are made to work for the average person, and averages are made of extremes.

I’d try taking a percentage less off and see if you can consistently reach your target.

We use Frenenius 2008. He does 8 hrs 5 nights a week. We have been adjusting by him drinking fluids that have not been added in. He really watches the sodium -and everything else he eats and drinks. Never a big fluid gainer. Do you have to take phosphate binders. He was taking renagel when 3x per week. We didn’t realize that they were the cause of the stomach problems he was having. After he stopped them no more heart burn. Phos now is below normal when he gets off in the morning.

Hi delphine!
Have you tested your home scale to make sure it is accurate? Some brands are not accurate at all. Other possiblilites are, he gives up fluid easily, so you may not have to count the prime and rinseback in the goal. But if you are not counting what he drinks on the tx in the goal, it is also possible that the machine needs an internal re-calibration or the water inlet may need to be adjusted.

Oh and delphine, it is good to know that when your husband stopped using Renagel that his heartburn went away. My family member discovered the same thing with another med, so we will be glad to hear that when Renagel is no longer necessary that will reduce the heartburn even more. This says it is the meds that cause so much of the burning effect.

We’ve used Tanita HD-317 scales and found them to be very accurate and repeatable.

You need to adjust for rinseback which is the amount the saline bag goes down plus the amount of saline you use to flush via syringes going on and coming off. To decide on how much rinseback to use if you’re on a 2008K add the tubing set volume and the dialyser volume – both are listed on the data sheets in each case. I believe the NxStage cartridge /blood line volume is also listed on the data sheet that comes in the box.

You also need to take into account net water losses, particularly if you are doing nocturnal, for perspiration (sweat) and transpiration (breath) and also for any fluid taken in during dialysis. We’ve found if we allow 100 ml when our UF goal is under 1200 ml or 200 ml when our goal is above 1200 ml we can come pretty close. Every individual needs to experiment a little to find what net loss allowance works best for them.

The formula is:

UF Goal = PreWeight - Dry Weight + Rinseback - net losses

This seems to work well with the 2008K, but not always with a NxStage machine. Each NxStage machine we have used seems to have more or less fixed error which we have to also account for in making the UF Goal calculation. The magnitude of that error shows up fairly consistently after a few runs.


My original reply pointed out that for Nocturnal you don’t need to allow for rinseback when doing Nocturnal with a Fresenius.

[QUOTE=Mel;11490]We have been adjusting things so that his BP does not drop. He usually feels good and has good BP. Really liking this nocturnal stuff and having all the free time in the day. For us a dialysis day started at 5 in the morning. An hour drive to the unit - 1.5 hours if the weather was bad or slippery roads. 4.25 hours on the machine and the drive home again. - 3 times per week. Now we don’t have to leave the house. There have been a few days when we have slept until noon!! Anyway thanks for all the replies.