As previously reported herein, since I have been using only 1.5% fluid for my peritoneal dialysis, my weight has crept up from a target dry weight of 143 pounds to 149. Last week, I called Fresenius Supply and am to receive, in addition to my regular supply order, an additional 8 boxes of 6 liters of 2.5% solution.
Before this gets too confusing, let’s review: My current prescription for PD using the Liberty Cycler is a single manual fill of 2 Liters at approximately 6 PM followed by hooking up to the Cycler at about 9:30 PM where there is a drain, followed by four fill/drain cycles of 2700 mLiters each, or a total of 10,800 mLiters. Following this routine/prescription, my last adequacy test of Kt/V of 1.98 is acceptable. My dialysis is working and the Kt/V suggests is adequate.
To preclude leg cramps, I tend toward using a 1.5% solution for all of my PD. My weight gain suggests this does not result in pulling enough fluid. Previously when I was mixing 1.5 and 2.5% solutions, my ultrafiltration, a measure of how much fluid is being removed, was consistently over 1000; now, with 1.5%, it is as low as 378 but mostly in the 6-800 range. The obvious solution is to work in more 2.5% solution but how much is the question?
When the 2.5% 6 liter arrives, I intend to work in a 6 Liter bag of 2.5% every other night as a starting point. I use two 6-liter bags per night, so this will be providing roughly half of the required fluid. Meanwhile, while straightening out our supply closet, I found five 2 Liter static bags and used one of them Saturday evening for my static fill. Sunday morning my weight, which for the last three mornings was 149.0, dropped to 148.4, and my ultrafiltration jumped up to 1109 from 654. This suggests to me that perhaps I can alleviate my weight gain by just using the 2-liter static fill at 2.5%. I did have a slight leg cramp but not of the severity that I had to get up out of bed and walk around. I will be using the 2 liter 2.5% bags for my static fill until Wednesday. I’ll let you know how it goes. There is no formula for this stuff, just cut and try as it were.
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