Tag: peritoneal (Page 15 of 47)

I recently ran across an article on the Fresenius-sponsored app, Patient Hub. In the blurb, CKD and dry skin aka Pruritus were discussed. Further research indicates that as many as half of dialysis patients are blessed with aP. As such, it behooves those of us on PD to know more about this situation.

What is pruritus?

The general term pruritus means very itchy skin caused by a long-term disease, such as chronic kidney disease (CKD).

What is chronic kidney disease-associated pruritus (CKD-aP)?

CKD-aP is very itchy skin that is most common in patients with advanced CKD and end-stage kidney disease (ESKD), but it can also happen in the early stages of CKD. CKD-aP is also known as uremic pruritus because the build-up of toxins and wastes in damaged kidneys, known as uremia, has been associated with itching.  Recent scientific evidence suggests uremia is not the exclusive cause of itching in CKD.  As a result, the more appropriate name for this condition is CKD-aP.

CKD-aP can bother patients a lot and get in the way of daily life.  Scratching to stop the itch can harm the skin, so finding the right treatments is very important.  CKD-aP affects each person differently, so you need to work with your doctor and healthcare team to find what works best for you. Because CKD-aP is often ignored by both patients and their healthcare team, patients may not get the relief they need.  This can lead to loss of sleep, shorter or missed dialysis sessions, fatigue, depression, and infections, among other problems. 

On a personal level, I have experienced scaly or rough patches on my skin often on my head and legs. Since I am also a diabetic, this also factors in. Several years ago my dermatologist suggested I use a prescription ointment named Triamcinolone Acetonide (lead picture.) It has worked wonders for me dispatching sore spots and itching in short order.

As mentioned in yesterday’s blog, I did contact my dialysis team nurse, requested several boxes of 2.5% 2-liter static dialysis fluid, and picked up four boxes this morning. So now time will tell if I can control my weight using only the 2.5% static bags. Having said that, I would like to inform readers that for an 85-year-old 100% disabled Navy Vet, I am feeling exceptionally well at this point, working hard in the yard, and looking forward to living. Yes I have to pace myself, and yes I have to rest regularly, but things are getting done. I even laugh and smile occasionally. Life is good.

Yesterday exactly on time as advertised, our roofer and the USAA Insurance estimator showed up and investigated hail damage on on roof from the May 9 hail storm previously reported. The estimator found that our roof had sufficient damage from the storm to necessitate replacement, along with several of the gutter guards, and the door to our single garage also has dents in it. All of this info was sent back to USAA and I have been informed (via phoncon 5/14/2024) that our claim is in the mill and should be completed within a matter of day.

Lastly for today’s blog, after years and years of a certain cereal for breakfast, in response to constant nagging as a result of my labs reporting I need more protein, with the help of my wife, I’ve worked eggs and sausage into my breakfast routine. I’ve also included “smear case” for supper on occasion.

Just about everything in Texas is bigger, even HAIL. This past Friday around 1635 the skies opened up and here in Pecan Plantation, depending on where you live (we are about 4400 acres), a golf-ball to softball-sized hail storm passed through, lasting about 10 minutes. Boy did it rip things up. No sooner than the last hail had bounced off roofs, the roofers were coming out of the woodwork, harking their particular company for roof replacement work. We got ahead of the curve, notified our home insurance agent at USAA, have an adjuster scheduled for 10-11 AM today, and a reputable local roofing company on call to also work with the adjuster. The roofing company’s rep came out Saturday and inspected our roof and said it needed replacement. We have three skylights, and the storm took out all three. What you don’t know is that the roof is only three years old having been replaced previously due to hail damage. So here we go again.

Here is a link to a DFW article about the damage in Pecan Plantation. Below is a short video I shot during the hail storm. It is shot from our front porch.

As scheduled, we received our monthly supply delivery from Fresenius. Our storage space is filled to the brim. The first photo below shows the “Ready Service Locker ” adjacent to the Liberty Cycler in our Master Bedroom. I currently use two bags of 6-liter fluid every night, so our locker holds ten nights’ worth of fluid.

The photo below is of a closet in a bedroom adjacent to the Master. In it, we store all of the bulk of fluids. To the right in the picture is our supply of 1.5% 6-liter bags; on the floor under the center shelving are the eight 2.5% 6-liter supplies I will be working in to help alleviate my weight gain; to the left are the 2-liter static bags I use in the early evening. As you can see, it makes up quite a bit but keep in mind I’m using one box of 6-liter every night so it goes down rather quickly.

Yesterday I alluded to mashing up a quick video of some of the yard work that my wife and I are engaged in. At this time of year in North Texas, we have to get out early or late to escape the heat. At 1:30 PM it is currently 86F with high humidity; tomorrow the high is predicted to be 92F so you get the idea. Our property is 0.5211 acres, more or less, with 15 or more flower beds. It is a handful to attempt to keep up with but we are doing just that. We have professional mowers on call, and a hit-and-miss high school lad helping us. It is still rather daunting but isn’t life itself? Keep-up is not in the cards nor is staying even but that’s what challenges are all about, right? Above all else, it makes for a very good counterbalance to the requirements of peritoneal dialysis. Here’s the short of what we have been working on:

I am scheduled for a Monthly Dialysis Team Meeting this Thursday at 0845. I don’t expect any surprises as we have been in the groove, so to speak, except for my concern about weight which appears we are approaching a solution. After using 2.5% 2000 mL for my static Sunday night my weight dropped from 148.4 to 148.0 and ultrafiltration was over 1000. We’re headed incrementally in the right direction.

Regarding my labs: My Albumin dropped to 3.4 from 4 so is below desired. My Calcium dropped to 8.2 from 8.7 and is below desired. My Glucose was 84 down from 149; I didn’t eat any breakfast before labs this time which explains this reading. Interestingly, my Creatinine was 8.76, down from 9.22 and “going in the right direction.” This maps to an eGFR of 5 putting me still in the toilet.

We’ve been steadily working in the yard. This AM my wife and I planted eight Lantana and used a pick to remove some rusted steel bed edging. Our twelve Roma tomato plants all have blossoms and are looking very healthy. A short video clip will be provided in a couple of days. I still get winded easily and have to rest frequently but we’re “gettin’ ‘er done!”

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.

Yesterday morning when I weighed myself as part of the routine for completing the night’s peritoneal dialysis, I weighed 149.0 pounds, up in a couple of weeks from 143.0. As I previously mentioned in a former blog, I am using only 1.5% dialysis solution which appears to not pull enough fluids out. I am strongly considering by hook or crook coming up with enough 2.5% fluid so that I can start working it into my daily PD treatment. Meanwhile, I asked Poe about weight and PD with the following results which are enlightening:

Weight management is a crucial aspect for patients on peritoneal dialysis (PD). Maintaining an appropriate weight helps optimize dialysis effectiveness, manage fluid balance, and promote overall health. Here are a few key points regarding weight management in PD patients:

Fluid Balance: PD involves the exchange of fluid in the peritoneal cavity to remove waste products and excess fluid from the body. Weight gain between dialysis sessions can indicate fluid retention, while excessive weight loss can indicate inadequate fluid removal. Close monitoring of weight helps in achieving optimal fluid balance.

Ultrafiltration: Ultrafiltration refers to the removal of excess fluid during dialysis. It is an important parameter for managing fluid balance in PD. The prescribed ultrafiltration target is based on a patient’s individual needs and is often calculated as a percentage of their dry weight. Regular weight measurements help healthcare providers adjust the dialysis prescription and ensure appropriate fluid removal.

Nutritional Status: Weight changes in PD patients can reflect alterations in their nutritional status. Significant weight loss may indicate malnutrition, while weight gain can suggest overeating or excessive calorie intake. Maintaining a healthy weight is essential for ensuring an adequate nutritional status in PD patients.

Cardiovascular Health: Excessive weight gain in PD patients can strain the heart and lead to increased cardiovascular risks. Conversely, rapid weight loss may be associated with muscle wasting and a weakened immune system. Moderate weight loss, if necessary, should be achieved through appropriate dietary modifications and under the guidance of healthcare professionals.

Diabetes Management: Many PD patients have underlying diabetes, and weight management is crucial for glycemic control. Achieving and maintaining a healthy weight can contribute to better glucose control and reduce the risk of complications associated with diabetes.

It’s important to note that weight management should be individualized based on a patient’s specific needs and goals. Regular monitoring of weight, along with close collaboration between patients, healthcare providers, and dietitians, is essential to optimize outcomes for PD patients.