The Fluid Factor and Home Dialysis

By Kore Nielsen, RN, Clinical Service Specialist, and Beverly Garcellano, RN, BSN, CNN

Disclaimer: This article is for informational purposes only and is not intended to be a substitute for medical advice or diagnosis from a physician

As a patient who dialyzes at home, you have certain benefits over those who dialyze in a center. You have the ability to do more frequent treatments in the comfort of your own home. You get to do them at times that work best with your schedule. And because your treatments are more frequent — sometimes daily — you have the added benefit of drinking more fluids. But that doesn’t mean you can drink as much as you want.

Fluid buildup, or fluid overload, increases your blood volume. This stretches your heart, raises your blood pressure, wets your lungs and causes swelling. If you frequently have swelling around your eyes, legs and ankles, and have high blood pressure, chest congestion or frequent coughing at night, you may not be reaching your dry weight.

Dry weight is your true body weight without extra fluid. As your dialysis provider, we will work with your doctor to establish a daily fluid allowance especially for you to help you maintain the right balance. It is important to attain your dry weight with every dialysis treatment so you don’t have to “play catch up.” Attaining your dry weight can help you fully enjoy the health benefits of removing fluid and toxins every day with your home therapy.

How to reach your dry weight:

  • Complete all your peritoneal dialysis (PD) exchanges or home hemodialysis (HHD) treatments as ordered by your doctor.
  • Fluid intake should equal the daily total of your urine output and ultrafiltration volume. Your dietitian will help you determine the amount of fluid you should be drinking each day.
  • Tell your nurse right away if you think your urine output is decreasing.
  • For PD, don’t rely on 4.25% dialysis solution (red bags) to help you remove fluid, as frequent long-term use can damage your peritoneal membrane.
  • Limit your sodium intake. You should be taking in 2g (2,000 mg) or less.
  • Remember that salt and sugar make you thirsty.
  • Stay as active as possible.
  • Always weigh and assess yourself before starting treatment.
  • If you gain a high amount of fluid every day, start a food diary and review with your dietitian for possible solutions.
  • If you have diabetes, maintain acceptable blood sugar levels.

The more fluid you remove in one session, the more likely you are to have severe cramping, dizziness with low blood pressure, nausea, vomiting and fatigue after treatment. Having too much fluid in your body has long-term consequences, including stress to your heart and lungs.

HHD gives you the option to dialyze frequently, five or six days a week or even every day. More frequent dialysis allows less fluid buildup and less stress on your heart.

Most people choose a home modality for the freedom of treatment times, improved quality of life and to feel better with more frequent treatments. Fluid management is one of the biggest challenges a dialysis patient faces, so always remember that your nurse and dietitian are more than happy to help you find ways to succeed.

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