Happy New Year?

OK, so it's a little late for a "Happy New Year" but it is my first entry of 2010. It had been a pretty quiet start to the new decade, just the way I wanted it, that is until just recently when I woke up on a Sunday to find that my ability to take a breath had been diminished greatly. Not wanting to miss the Cowboys/Vikings game, I waited a few hours to consult anyone. Needless to say, I ended up in the ER and subsequently, Northeast Methodist, with my very own case of pneumonia.

Pneumonia is an accumulation of fluid in your lungs which in turn get infected because it just kind of sits there stagnant. It's a problem that is forever lurking over our collective shoulders. Pneumonia's epidemiology, or prevalence in hemodialysis patients, hasn't been concretely proven but in a study conducted between 1996 and 2001 Medicare tracked over 200,000 cases of pneumonia in dialysis patients. (http://ndt.oxfordjournals.org/cgi/content/short/23/2/680 )

So after 3 days of breathing treatments, IV antibiotics and far too much swabbing, I was released and I've been feeling much better lately. After a year on dialysis I've kind of entered a glide pattern. Nothing really changes too much from treatment to treatment. You have the occasional fluctuation of your dry weight that needs to be corrected but other than that it's pretty standard stuff day in, day out.

I guess if I want this blog to be somewhat educational on the processes of dialysis and not just an unsolicited look into my life, I should explain what a "dry weight" is. Dry weight is simply your weight with as little excess fluid in your body as possible. Basically, in a person with normal kidney function the dry weight would be their weight after they've gone to the bathroom.

Because a failed kidney cannot filter the blood properly one consequence is that excess fluid will build up in the tissues, including the lungs, of a patient. This is called fluid overload and without treatment it can lead to the patient literally drowning in their body. Personally, it's not a great feeling. So in order to assure that this particularly uncomfortable death does not come to any of us, along with having our levels of potassium, phosphorous, urea and creatinine lowered, they also pull off as much excess fluid from the blood as possible.

So that's what the dry weight is, the lowest weight they can get you to by pulling off the extra fluid from your blood. Maybe you ask yourself, "why does he say 'as much as possible'?" And to you I say, good question but this isn't a classroom, keep that to yourself. I say "as much as possible" because there is something called the "dialysis hangover" or "dialysis washout." It is caused by too much fluid being pulled off in one treatment, or can be caused by the fluid being pulled off too quickly.  "Dialysis hangover" is usually characterized by these symptoms, but not necessarily all at once: headaches, nausea, muscle cramps, a drop in blood pressure and fatigue. These complications can resolve within minutes or they could last for a day or so.

 Maintaining your dry weight, while one of the most essential jobs performed by the dialysis treatment, is also the one that will affect the patient the most. There are ways to avoid the "hangover," mostly they involve proper fluid control on the part of we the patient. Basically, knowing your weight, knowing how much fluid you are taking in between treatments and not going over your allotted amount. This sounds easy enough but the recommended fluid intake between treatments for most patients is 32-50 fluid ounces per day, or 64-100 fluid ounces total. 32 fluid ounces is roughly equivalent to a bottle and a half of soda a day. An average person with normal kidney function has a fluid intake of 100 fluid ounces a day. That 32-50 fluid ounces a day doesn't just include water, juice or whatever you drink, it also includes anything liquid you could have. Soup, ice cream, basically any food that is liquid or can melt will count against your daily allotted fluid intake. Now, that 32 ounces a day rule isn't fast and firm. If a patient has residual kidney function that will allow them some wiggle room with their fluids. That's something I have been blessed with for this first year I've been on. I think this latest bout with pneumonia is the death knell for my willy nilly fluid intake.


It's important to know your weight and to weigh yourself regularly at home to make sure you are not gaining too much between treatments. Ideally they would like patients to gain no more than 5% of their dry weight. For me and my 81.5 kilograms that would be a gain of 4 kg in the day and a half between treatments. Not knowing your dry weight, or keeping up with it at home can lead to the fluid overload but it could also lead to the patient just having a little fluid left in the body which, if not caught, can sit there long enough to turn into the pneumonia that lands someone, let's say me, in the hospital.

Dialysis is a partnership. The dialysis nurses and techs are responsible for as much of the patients' care as the patient is. Most dialysis patients know what temperature their dialysis machine should be set to, or how much Heparin, an anti-coagulant, they should get. Knowing these details will ensure that nothing is inadvertently missed by those taking care of you.

Starting with this blog, I'm setting up a new structure. Because dialysis can be the headquarters for tedium, at least from the standpoint of the patient, I'm going to be writing an entry on the first of every month that will cover everything pertinent that happened the month before. It will just assure that I actually come with something interesting for yall to read. I will still write if something particularly emergent occurs and I am moved to write about it immediately. With that I close the book on January 2010, month 13 on dialysis. Until next month, I wish you all good health and great love.