@ JohanneCPoirier

Wow what a great description of what happens in the human body during dialysis. Thanks for sharing your knowledge and experience

So this is why we advised dialysis patients to never have more then 4 litres to remove, if they keep fluids down to 1 litre per day, they will have only 2 L to remove, but unfortunately some patients came in with 5 (11 lbs) to 6 kg (13.2 lbs) to lose (hence knowing they over dranks fluids). Now fluids is not just what you drink, here are a few fluids you need to count in that 1 Litre per day : yogourt, soup, jello, ice cream, fruits and veggies also contain fluids, so one patient was eating water melons in huge quantities yet he could not figure out that water melons is that Water, so the juicier the fruit, the more water it contains. So dialysis patients require lots of supplements and some pills are huge, they need to swallow with fluids, so this fluid counts toward your 1 L per day also. It is not easy being a dialysis patient, especially because both diabetic and dialysis diet are total opposite and it makes it harder to manage diabetes, but the diet required for kidney failure is now the one they must follow, medications can regulate the diabetes if need be. I hope this helps answer a few questions abvout dialysis and why feelind so tired afterwards, most patient stated they had alternate good days and bad days, dialysis days they had to rest a lot, the next day some felt better and did chores or errands on those good days.

People make dialysis seem so easy, you go there and sit a few hrs, then leave, but for the body it is much more complicated then that, it is the before and after which is not easy, during neither, some patients require medications such as Gravol to be able to get through dialysis. For some few people they require a medication given in the hr preceeding dialysis to maintain their blood pressure just to be able to dialyse the fluids. 1 day at a time.

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Now some dialysis patients cannot eat during dialysis or they vomit or have irregular HR and BP fluctuating. Reason being is this, for 1 hr following eating (this is for everyone, it is how our brain works), your blood gets distributed to your stomach to help digestion, so less circulating to heart and other major organs, but Hey Brain is still trying to deal with the loss of blood and fluids which is being sent to those major organs, so a battle begins, between the brain trying to save your life and your stomach requiring more blood to aid in digestion, which is why most patients choose not to eat as they really feel nauseated when doing so, some nibble instead, but most wait till they finish dialysis, or eat right before starting while BP is higher. We always reccomended people not eat during dialysis till their bodies could tolerate dialysis better, some ate huge meals during their session and were not affected, but had been on dialysis a very long time. Some used glucose tabs if they dropped their sugar levels, or even candies here and there during the session, but only if required. As it defeats the purpose of dialysis.

Now lets go back to losing so much fluids during dialysis and electrolytes, well it may cause cramps, may cause dizziness also, I have even seen people faint. It is really hard on the body to lose so much fluids and electrolytes it is like having a real bad gastro/diarrhea, your body needs time to recover, we were never meant to lose 4.4 lbs in 4 hrs. What a normal person with functional kidneys do over 48 hrs period we are now doing this over a 4 hrs period (as most dialysis patients come in 3 times per week, the after weekend 3 days is the hardest on most as they may have 6.6 lbs or 3 L to remove), so YEAH the body is very tired it is like working overtime.

Now when someone is connected to a dialysis machine, you are removing the equivalent of 1 unit of blood which will be circulating outside the body, so your body senses this is the way our brains are programmed since birth, when we lose blood, we also lose HGB so our bodies say Woah I need to bring the blood pressure down ( so that I do not bleed out too fast) and speed up the heart rate so that the major organs get their supplies of blood and oxygen. Dialysis patients body does not know the blood is recirculating in a machine and will be given back to them at the end of dialysis (our bodies were not programmed that way). So this causes higher HR and lower blood pressure. So as the session goes on you are also losing a lot of fluid at 1 lbs per hr, so your brain says HEY I am still bleeding out, I need to decrease the blood pressure further and pump the heart faster. You also are losing electrolytes over these hrs, lets take K (Potassium as example), if your K is too high you get irregular heart rate and heart complications, so now your brain says HEY not only am I losing blood, but K is dropping also (and many other electrolytes drop such as sugar levels), so it has to compensate. So nearing the end of dialysis your K might have gone from 6 to 4 (by osmosis), your sugar might drop my half for some diabetic (which is why sometimes we have to add glucose to the solutions if someone always drops their sugar too low, hence testing before and after dialysis and some in between. So now you lost 1 unit of blood, 4.4 lbs of fluid, electrolytes etc... Now your brain is so confused how rapidly your fluid shift and electrolytes it causes a disequilibrium, hence why 4 hrs is the most that people can tolerate on dialysis (unless in ICU where they remove slowly over 24 hrs which they use a different machine for this). So now the end of dialysis, your nurse gives you back your blood and fluids to push the blood out of the system and into you,it is like reciving 1 unit of blood in a few minutes (usually given over 1 to 2 hrs if actual blood bags are given to non dialysis patients. It takes quite a few minutes before your brain can make the transition of slowing down your heart rate and bringing up your blood pressure, so this is why most patients can get dizzy upon standing up, as your brain needs time to adjust to this shift. So now you understand HR and BP. But what of sugar levels, well they can drop, hence why sometimes long term dialysis patients might require less diabetic medications over time, some even come off them completely (not often though).

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