Is this the right board for info on this and sodium modeling? My unit does not seem to know how either of these programs work although we have machines that offer them. I have to get info so I can explain to them how to do it. I know, backwards. I never gain more than 2 kgs, but have problems with my bp lowering somewhat and my legs and feet feeling jittery about 2 hours into my tx. I have rasied my dry weight and don't have any other dryness symptoms. Can you tell me what's going on, if these programs would help me, and if so, what does my staff need to do to get me started?

Dear Toni,
I will do my best to answer your questions. Normally, ultrafiltration is performed at the same rate over the course of the dialysis treatment.There is some thought that a constant rate of fluid removal may not be the best approach, especially when the sodium concentration(sodium profiling)is being varied during the treatment. Some dialysis machines allow for the majority of the fluid to be removed during the first portion of the treatment and for the clinician to devise several other forms of ultrfiltration profiling. I am not certain that there have been many studies done to prove the benefits of such therapies, but I do know that uf profiling works well for some patients.
Regarding sodium modeling or profiling: This option on some machines allows for rapid alteration of the dialysate sodium concentration by chooising one of many options available through the machine. The sodium concentration is usually altered by changing the proportions of "acid concentrate" and water.A higher sodium at the beginning of the treatment, allows for more rapid fluid removal. It is important to return the sodium to the baseline prior to the termination of the treatment, otheerwise patients can have excessive thirst which will cause more fluid consumption. Many patients on dialysis complain of "restless legs" duribg the treatmnet. This can be due to rapid fluid removal or just the flux of electrolytes back and forth across the dialyzer membrane.
Another approach to fluid removal, is to use a volume monitor such as the Crit-Line. Using this monitor can help the clinician to know when the patient will experience some type of interdialytic event. If you would like further information on this product, you can visit the web site @ www.crit-line.com.
I hope this is helpful to you. My best wishes to you and good luck.
Nancy

Nancy,
Thank you for your explanation of these procedures and for confirming to me that restless leg symptoms on the machine is expressed often by pateints. I come home from tx sometimes and my legs then feel sore and hurt thoughout the evening. If I didn't have these symptoms prior to being on the machine, it's obvious to me that something occuring on the machine is causing it. Can you go into a little more depth on what you mean by rapid fluid removal and the flux of electrolytes back and forth across the dialyzer membrane? And with the Crit-line intercepting dialytic events, do clinicians then know what to do for restless leg symptoms? Since my staff does not seem to know how to do profiling and doesn't own a Crit-line, how can I influence them to learn what my symtoms are and deal with it? To me this is a case of my staff not knowing how to fully run a tx and their needing education. They sort of have an apathetic attitude, but I've known them to snap to it if a patient presents them with the facts.

Dear Sadie,
Rapid fluid removal can cause sore painful legs and can also affect arms. During dialysis, electrolytes like potassium and sodium move back and forth across the cell membrane. Potassium, which is found mainly within cells,can transfer to the serum, while sodium, which is found mainly within serum, can transfer to the cell. After dialysis, it takes a while for these substances to equilibrate(balance out). This can also cause your legs to feel tired, heavy and sore.
The Crit-Line is a monitor that gives the clinician a "window" into the patient's intravascular(within the vessels)space. Proper use of the monitor can optimize fluid removal while preventing morbid events which can result from blood volume depletion. This occurs via staff control of ultrafiltration while monitoring in real time, graphically displayed changes in the patient's circulating blood volume during the dialysis treatment.
I hope that this explanation is clear to you. Please wrie again or e-mail me directly if you have further questions.
Best wishes and thank you,
Nancy

So that's why my legs are so hard to move after dialysis, because of the potassium/sodium balance? I thought it was something to do with lactic acid buildup.

Dear DialyznDar,
If you are dialyzed with a bicarbonate based dialysate, lactic acid build up should not be an issue.All Bicarb. solutions have acetate added in the form of acetic acid delivered through the acid pump in the machine.The pH of the dialysate should be checked manually prior to initiation of the treatment and it is monitored over the course of the treatment internally. Hope this helps. Please feel free to write again with questions.
Best,
Nancy

For several txs in a row my legs ached terribly all evening long post dialysis. I've had this many times post dialysis off and on. It was so awful I could hardly stand it. Fortunately there is one thing that helps greatly, and that's massage. Do you know, is it in any way dangerous to use massage for this condition? The next tx., I raised my goal just .1. By going up just a little bit, it completely eliminated the problem, so is there a correlation between leg soreness and being too close to ones dry weight? I've had this leg soreness when I came out .1 under as well as .1 over, and whether my bps were good or lower. Could this be caused by simply running too dry?

Also, I read your explanation above about electrolytes and I would like to say that I had a terrible case of jumpy legs on dialysis and my feet would jerk like they were going into a cramp. I could hardly handle the tx. I switched to non-reuse and these symptoms ceased from the very first tx. The RN said I must of had an allergy.