Management of Fluid Status

It is important to avoid excess weight gain between treatments. Gaining too much increases your chances of dying, increases your chances of being hospitalized and makes it more likely you will develop heart problems.  Also gaining too much may make you either feel sick before dialysis or feel more washed out after dialysis.

I understand that this is difficult for lots of patients and even more difficult for patients who do not make much urine.  If you make some urine, we can try to increase that by giving you a high dose of a water pill. (We need to stop the water pill if your urinations stop). In general you should try to get your weight gain down to between 2-3 kg.

We determine what the maximal amount of fluid is that we can safely remove during your treatment. Aiming for larger amounts especially when it happens over and over can lead to heart and brain problems which you really do not want.  The maximum fluid removed is printed on your dialysis paperwork.  This is just based on your size and how long your treatment is.  Many patients get symptoms if we try removing that much so we always aim for less removal in them.  Other patients feel Ok with more fluid removed.  The bad effects on your heart and brain may still occur even if you have no symptoms so we should not go above the maximal fluid removal if possible.

We have many patients who gain more than we can safely remove.  We try to remove the most we can which still then leaves them over their target weight. If that happens to you, we need you to particularly try to drink less until the next dialysis.  If need be, we may ask you to come in for an extra dialysis.

If you are one of our patients who tend to gain too much fluid, it is either due to eating too much salt (which makes you thirsty) or just due to drinking too much. You may already know what your problem is. You also can ask your doctor to look at the level of sodium in you labs.  If it is normal, then eating too much salt is likely your main problem.  If it is low, then just drinking too much fluid is the main problem and eating too much salt is either less of a problem or not a problem at all.

For those of you who need to decrease the amount of salt you eat to decrease your weight gain, I know that it is very difficult.  The first step is to decide you want to do this for your health.  I know that most of you long ago stopped adding salt to your food, but lots of food itself is salty.  Please work with the dietician to identify where salt is sneaking into your food.   Also remember that eating salty food during dialysis is still eating salt.  It is not true that you can safely eat salt in dialysis because we are taking it out.  Unfortunately, much of that salt stays in you making you thirsty later.  Also, your taste buds need to get used to low salt.  If you eat salty foods in dialysis, you will be unhappy with low salt foods outside of dialysis.

Your Doctors are available at answer any questions you may have about this.

Posted in Dialysis Blog.