By Kathy Wolgemuth, RN

Take and record your weight and blood pressure! Get in all of your daily peritoneal dialysis! Measure your urine output! Watch your fluid and salt intake! Look for swelling!

Do you hear all this from your dialysis nurse, dietitian and doctor? Is it really necessary for you to keep track of all of this? Simply, the answer is yes.

It is important to know the why and how of managing the fluid in your body while receiving peritoneal dialysis. The why is for your general well being. There is evidence to support the notion that keeping the fluid in your body under control helps to impact blood pressure that in turn helps to prevent heart problems.(1,2)  Fluid control also has an effect on preserving residual renal function and maintenance of appetite and nutrition.(1)

The how takes some planning on your part. You should recall from your peritoneal dialysis training that the kidneys balance fluids in the body. When the kidneys are healthy, they rid the body of extra fluid by way of urine. With kidney failure, the extra fluid must be removed by dialysis.

You should know your target weight (3) and acceptable blood pressure range. Discuss this with your dialysis nurse and doctor and be sure to take and record your weight and blood pressure every day.

Complete your dialysis exchanges as instructed. Do not skip CAPD exchanges or shorten your cycler times. Be aware of how well you are draining. If you are experiencing changes in how well you drain, be sure to report this to your dialysis team.

Keep your daily fluid and salt intake to the allowed quantity. The amount of fluid you are allowed to drink is based on how much is removed through dialysis and urine. It is important for you to keep track of your 24-hour urine output and inform your team of any changes in volume. If you find it difficult to limit what you drink, there are some things you can do to help yourself. Spread your fluid intake throughout the day, allowing for meals and medications. Measure what you drink each time - you may be surprised how much liquid your favorite mug holds! Don't forget that ice is a liquid at room temperature. Try substituting hard candy (sugar free for diabetics) for a drink of fluid.

Avoid using more salt than recommended. Try using herbs or other products that your dietitian can recommend. Food does not necessarily taste bad without salt if you find other things to spice it up.

Fluid overload can occur if you have too much fluid in your body. One sign of fluid overload is swelling, which is noted in the feet, legs, hands and under the eyes. Other signs include higher than usual blood pressure and shortness of breath. Increasing the use of higher dextrose solution and decreasing your salt and fluid intake can treat this.

Just as you can become overloaded with fluid on peritoneal dialysis, you can become dehydrated. This might happen if your target weight decreases, if you are using too much high dextrose solution, or if you have been ill with diarrhea or vomiting. The signs of dehydration are lower than usual weight, dizziness and dry mouth. The treatment includes using lower dextrose solution, drinking more fluid and re-evaluating your target weight and daily dextrose solution usage.

If you travel, you must remember that although you are on vacation, you should not take a vacation from caring for yourself. It is especially important for you to keep to your dialysis schedule and fluid and salt restrictions. Although you may try your best, it is difficult to limit salt when you are away from home or eating in restaurants. Be sure to include some higher dextrose solution bags in your travel order in case you need it.

As you consider all of these things, remember that your dialysis team is available to you to answer your questions and help take care of you.

References:

Nophl, Karl (2000). Special General Session on Ultrafiltration Management in Dialysis Patients. Peritoneal Dialysis Today - Highlights of the 28th Annual Conference on PD. Vol. 6, No. 1, pg. 11.

Blake, Peter (2000). Trends in Patient and Technique Survival in Peritoneal Dialysis and Strategies: How Are We Doing and How can We Do Better? Advances in Renal Replacement Therapy. Vol. 7, No. 4, pgs. 324-337.

Mujas, Salim (1999). Ultrafiltration Management in Peritoneal Dialysis. Peritoneal Dialysis Today - Highlights of the 19th Annual Conference on Peritoneal Dialysis. Vol. 5, No. 1, pgs. 3-4.

Kathy Wolgemuth, RN, is the Head Nurse of Home Dialysis at the Central Florida Kidney Center in Orlando, Florida.

This article originally appeared aakpRENALIFE, Vol. 17, No. 1, July 2001

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