The irresistible urge to pull off the very last drop of fluid

Yes, I always have that. So do most people on dialysis. When we go in for a session, we want to pull off every bit of excess fluid. Even if it means cramping a little or feeling weak after the dialysis session.

What is the necessity to remove more fluid than you actually have? This is something only people on dialysis will get!

The crux of the matter is we are better off pulling off more than less. We never want to get off dialysis with any extra fluid. To make things more complex, it is very difficult to tell for sure how much above our dry weight we really are. There are a lot of factors involved. The amount of food we have had in the past few hours, the kind of food, the overall increase or decrease in dry weight over the past few day and other such things.

There have been attempts by the medical community to develop tools to determine exactly how much excess fluid is there in a patient's body and hence accurately determine how much fluid to remove. However, these tools have still not gained wide acceptance, at least in India.

So, where does that leave us?

All we have is subjective measures of the fluid weight gain. The dry weight is not assumed to have changed unless some symptoms are noticed. For example, if a patient cramps during dialysis regularly, it is assumed that too much fluid is trying to be pulled off and that the dry weight has increased. If the patient has breathlessness or a high BP, then it is assumed that too little fluid is being removed and that the dry weight has probably decreased. Again, there are multiple other reasons why the above two symptoms can also happen due to, so the game becomes all the more difficult.

This leaves the person on dialysis always wanting to err on the side of caution. Remove every single possible drop, that is! If we do not reach our known dry weight, we will feel so horrible. Like we have been cheated! Like we have undergone the horrible thing called dialysis and all the fluid wasn't even removed! The main problem with this is that now until the next dialysis session, we will have to restrict our fluid intake even more than usual because there is already some fluid left behind in our body and not restricting this would lead to all kinds of horrible symptoms like breathlessness, swelling in the feet etc.

What unholy crap!


This has definitely become the central focus of my attention in the last few weeks. I have some residual function in my transplanted kidney, but it has gone down dramatically. It's remarkable how obsessed one becomes with one's weight and water removal.
Avinash Ghimire said…
a crit line on the dialysis machine is the single best invention in dialysis that I have seen recently.Slowly,these are being made standard here in the US.They do a tremendous job of informing us about the fluid aspect of dialysis care and how to remove it safely.I hope it crosses over to that part of the world sooner.