Wednesday, January 13, 2010

Dialysis: Learning to Adjust

So it turned out that adjusting to the reality of dialysis was the easiest adjustment to make. The reality of dialysis involves more than just adapting life to a new schedule. It involves a total surrender of lifestyle to the demands of treatment. Weight control, fluid intake restrictions, diet restrictions are just a few of the new issues that dominate life with dialysis. The driving goal in life becomes getting good lab results. 

The most important issue is managing weight gain between treatments. A treatment removes a minimum of 1.8 kilograms of fluid waste and a maximum of 6.0 kilograms. The waste includes excess water that is normally removed by the kidneys along with various waste materials produced in the body. Each patient is assigned at 'dry' weight and the goal of each treatment is to remove the necessary amount of fluid to reach that weight.

So the first thing a patient does when called to the treatment area is step on a scale and relay the weight to the patient care technician who then subtracts the 'dry' weight from the actual weight. The difference is the amount of fluid to be removed. 

In my case, I'm a big guy. My dry weight when I started dialysis was 115 kg. If I weighed 120 kg. when I arrived, the treatment would have to remove 5 kg. That's 11 pounds for you non-metric folks! AND that's a LOT of fluid to pull out of a body! The results of taking off that much fluid are headaches, nausea, cramping and loss of blood pressure, any one of which can cause the machine to be set on minimum, which means that the job of blood cleaning is not getting done.

Thus the most important goal between treatments is weight control. The easiest way to put on weight if your kidneys aren't working is to consume fluid, so fluid intake should be restricted to one quart per day, 32 ounces, 4 - 8 oz glasses of water. I repeat, restricted to one quart combined of any liquid:  water, tea, coffee, gravy, soup, ice cream, hot sauce, popsicles, not to mention beer, which has so many other things that cause problems with dialysis that it's totally out of the question. Well, out of the question if effective dialysis treatments that don't cause illness are the goal.

Unfortunately, the amount of food consumed impacts weight gain as well. (Is that really true??? DAMN!!!) That leads to the question of which foods contribute to more successful treatments and which ones don't. Now the path leads to chemistry of nutrition and things really get complicated.

And that's a story for another night.

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