I am not a big fluid gainer, nevertheless, I have a problem getting enough fluid off at txs. I start off the tx with a bp that is 120 something to 140. I was recently taken off bp meds. By the end of my txs my bp is dropping close to 100. By the end of the next day, I'm feeling tight in the chest eventhough I've not gone over my limit. I have no idea how other patients can come in with such excessive gains. I would have nowhere to put it. I can very much feel the fluid pressing in on my heart. Can somone tell me how to get the remaining fluid off? Is there any kind of procedure to do this other then just getting on the chair for extra time to remove more fluid? I don't want to be cramped to find out what's left onboard.

LeaAnn,

Does your clinic utilizes Fresenius 2008H machines? If so, ask them about using a feature called UF Profiling. UF(Ultrafiltration) is how the fluid is removed from your bloodstream. If this isn't being used, the machine is probably pulling an even amount of fluid throughout the course of your treatment. (Example: A goal of 4000ml over the course of 4 hours would result in removing 1000ml per hour.) However, if UF Profiling is used, the machine can be programmed to remove more fluid at certain times then at others but would still reach the same goal.

Example:
1. A goal of 4000ml over a 4 hour period could be programmed to remove 1500ml during the first hour, 1000ml during the second & third hour and 500ml during the fourth hour.
2. 1500,1000,1500,500
3. 2000,1000,500,500
4. 2000,1000,1000,0

The machine has preset profiles or they can create one that would be best for your needs.


Good Luck!!

I use Profile 5, and I've had good luck with it-- no cramping or crashing. I can't tolerate ANY fluid coming off in the last hour, which is why I was getting so sick before I went on the profile.

It's still not being widely used in our unit, because most patients don't want to know more about their treatments-- which is a real shame, because the profiles could stop a lot of the discomfort that patients are having with too-rapid fluid removal. But you can't force people to learn.

Thanks renalman and DialyzinDar,
You may have given me the solution I've been hoping to find. I have known about UF profiling, but was scared to try it, because my staff dosen't seem knowledgeable on what they're doing. I asked them if it would help with my problem and they replied that it was only for big fluid gainers, but I could try it if I wanted to. I've read elsewhere that that's not the case. So, I've wanted to find someone who could walk me through it before allowing my staff to make a guinea pig out of me.

I do dialyze on a Fresenius 2008H so how do I determine which one of those profiles is right for me? I see 1-4 but no #5 DialyzinDar. I don't want to try a profile thats wrong for me. What could happen if I did? How exactly did you feel the last hour D.D.? I just start feeling sick and the fluid doesn't want to come off and my bp goes lower and lower. I do get off what I set the goal for, but I feel I need to take off more and can't because my body won't tolerate taking off more. Are you saying that some people just cant handle rapid fluid removal and that is what causes the symptoms?

Uf profiling is designed to customize the treatment so it is more effective. The one thing we have all learned over the past 15 or so years is that dialysis is not a precise science, different people react in different ways. While we know the things that are harmful, now we concentrate on what can make a more effective treatment without stress on the body.
As renalman said the uf profiling is designed to pull more fluid when the person is able to tolerate it and less when they are unable to tolerate it. Some people will have problems when they are first put on the equipment others will cramp or become hypotensive at the end of the treatment. So which uf profiling is best for you has to be determined by you. The only risks that are involved in the "wrong" profiling are bp dropping, possible not reaching uf goal, there really aren't any dangers inherent to using the "wrong" it just staggers the uf rate overtime trying to remove the most fluid when it is best tolerated. As I suggest to everyone keep a journal and track your treatments. It is beneficial to record how you felt and what was done so when you have a good run you can repeat it. Hope some of this helps.

LeeAnn, Are you diabetic? We use profiles with the 2008K machine and the Althin 1000. With use of the Crit-lines we can see that the diabetics pull very easily the first 1.5-2 hours. We can pull most of their fluid in those hours without any symptoms. Then we just clean, and don't remove fluid the last part of the treatment. The 2008 machines have standard profiles 1-4. The center can program or customize other profiles that are then entered into the machine and given a number. Profile 6 in one center is not the same as profile 6 in another center.

In the last hour I feel ok-- I'm able to leave the unit as if nothing happened. When I get home I've got a good appetite, although I'm usually sleepy after dinner.

You'll have to try different profiles until you find one that your body likes... I was on Profile 2 for a year, but I started cramping in the third hour, so I switched to 5. Some profiles are easier to deal with than others... but I feel ANY profile is better than trying to 'keep up' with the machine and not having the fluid to give!

Honey,
No, I am not diabetic. Thanks for explaining about the 4 profiles and how the rest are programmed in.

techanswers and DD,
Ok, so I just pick a profile. If its the wrong one for me and my bp drops, what do I do? Because the next thing that happens when my bp drops is I cramp or pass out. At leaste now, with a straight tx, I'm not doing that lol. Are you saying to find the right profile I have to risk this?

If you know that you get ill the last hour and cramp and get dizzy, you probably need a profile that takes most of the fluid off at the beginning of the treatment.

I 'took a chance' and tried two profiles. There's no way of telling if it'll work for you unless you try it-- and unless your nurse or tech is willing to keep an eye out for problems that may develop. If you've got a staff that can't be bothered to answer alarms promptly, don't risk it.

DD and others,
If I try a UF profile and I experience cramping what should be done? What changed that after two years the profile you were on no longer worked for you? How did you decide which profile to try next? Are you also on sodium modeling?

ok, now we know about the Fresenius machines do other machines have this feature of step or uf profiling?? I am on Cobe. and clinic is in process of reto-fitting to Gambro Phoenix (I think).

which profile bests meets the refill rates in compartments?