Kidney School™—a program of Medical Education Institute, Inc.

Module 10—Getting Adequate Dialysis

Scale

Volume of water in your body

How much water is in your body, anyway? There really is no easy way for your doctor to tell how much of your weight gain is water and how much is fat or muscle. In fact, this is one of the biggest reasons that dialysis adequacy is part science and part art. But you can watch your body for signs of excess water, called edema (eh-dee'-muh). Extra water may make your face, hands, or feet puffy. If extra water is in your lungs, it can make breathing harder. Always having extra water in your body can make your blood pressure impossible to control, even with many pills. High blood pressure is the main risk factor for heart damage called left ventricular hypertrophy (LVH), which is one of the leading causes of death for people on dialysis. If you can't limit your fluids enough to do standard in-center HD without high blood pressure, changing to a longer and/or more frequent type of home HD may help protect your heart.

Your goal weight without excess water is called dry weight. One way to find dry weight is to take off so much water that you get low blood pressure and cramps, and then back off from there. This is not recommended, but there is no practical, clinical way to assess dry weight. It is always trial and error.

As someone with kidney failure, it's up to you to tell your care team if you believe you have gained fat or muscle, so your dry weight can be adjusted:

My blood pressure tends to run high, so I want to get as dry as possible. You, on the other hand, might feel better going back to your old way of calculating your goal and leaving a little fluid on. My dry weight is different every treatment. I 'feel' my way dry. I say to the nurse, 'I feel like I need to take off X.X kilos today, please.' If I hit dry before my time is up, I have them back my goal down a little. If I feel a little over when I leave, I will add more to my goal next time or try to add it on when I still have a half hour left. It's a fine line and everybody needs to figure out for themselves what weight is most comfortable.

It's also up to you to learn the signs of getting too dry at dialysis. There is no such thing as "overdialysis," but it is possible to remove too much water at a treatment. When too much water is removed, your blood gets thicker and harder to pump. To make it easier on your heart, your blood pressure will drop. Here is a list of symptoms people get when too much water is removed. Check off the ones you have felt yourself. If you learn what it feels like to get too dry, you can alert the staff at the first moment you feel the symptom—and feel better faster:

Dizzy, faint, lightheaded
Ringing in my ears
Racing pulse
Feeling warm, sweating
Nausea or Vomiting
Yawning
Itching
Severe muscle cramps (anywhere on my body)
Other:

How Can My Low Pressure Be Helped—Fast?!

If you have lost too much water during dialysis, giving you back a little bit of fluid can help. Depending on how you feel, you may get some saline in your dialysis lines, or be able to drink some broth or other liquid. It also helps to recline the chair so your head is lower than your feet.

Page 9 of 23 | Further reading