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Questions and Answers About Your Health

The Importance of Dry Weight

Question:

I’m told that I am above my dry weight.  What does that mean?

Answer:

Normal kidneys keep the amount of fluid in our bodies regulated appropriately.  As we lose kidney function, sometimes diuretics are needed to further regulate it.  But when we are on dialysis, the machine has to remove the fluid.  Your physician and nurse will attempt to ascertain what weight you have at the right amount of fluid.  Most dialysis patients carry too much fluid, really salt and water.  The consequences of this are high blood pressure, heart enlargement and early death.  Therefore it is important to get the “dry weight” correct.

Taking in too much salt, which makes you want to drink more fluid, makes the dry weight go up.  The dialysis machine then has to take that excess fluid off, sometimes causes low pressure and cramps during dialysis.  The best way to assure attaining a dry weight with ease is to eat little salt and gain less weight. 

If you are taking multiple blood pressure medications, clearly your dry weight is too high.  You might talk to your doctor about reducing the medications and reducing your dry weight.

The Importance of the New Dialysis Reimbursement Program

Question:

I have been hearing about the new reimbursement method that Medicare is using to pay for my dialysis.  How will this affect me?

Answer:

Beginning January 1, 2011, Medicare will change the way it pays for dialysis services.  As a patient of Renal Ventures clinics, you will receive a letter that explains this.  Essentially certain services, labs and drugs, that previously the dialysis facility billed to Medicare separately, will all now be “bundled” into one lump payment.

There are several things that are important for you.

The foremost has to do with the quality of your care. Quality of care will not change and, if it does, it will likely get better.  The regulations include requirements that certain quality measures be maintained.  Renal Ventures has always excelled in this area.  Our quality outcomes for the facility and patients have always been better than regulations require.

We have worked closely with experts and advisors to develop new protocols that will assure this quality.  We have been traveling to each facility to educate staff and physicians.  They have endorsed the changes and agree that there will be no compromise with regards to your care.

If you are a Renal Ventures patient, look for the letter to explain things in more detail.

The Importance of Getting Your Catheter Removed

Question:

I have a catheter.  My doctor wants me to change to another kind of access for dialysis.  Why?

Answer:

Sometimes catheters are the only access that can be used for dialysis, after all other possibilities have been exhausted.  However, if this is not the case, then it is imperative that the catheter be removed.  The short version is that catheters cause more hospitalizations due to infection and cause higher death rates.
 
Patients who have catheters generally have about 4 hospitalizations per year, due to severe infection.  And there is more than double the probability of early death.  Only about 2-3% of patients should have catheters in place because all other access possibilities have been eliminated.  If you are using a catheter simply because it is convenient or you don't want to be stuck with a needle, you need to be fully aware of the dangers and the poor outcomes you will likely have.
 
If you have a catheter, you should tell your doctor that you want another kind of access and to have the catheter removed.

The Importance of Time on Each Dialysis Session

Question:

Even though my Kt/V is OK, my doctor wants me to have more time on dialysis. Why?

Answer:

Recent scientific studies have shown that just attaining a sufficient quantity of toxin removal (Kt/V) is simply not enough. Kt/V does not measure the amount of salt and water removed.  It is very difficult to remove the correct amount of fluid in the body in less than 4 hours. Therefore, there are enormous efforts by the medical community to increase the time of each dialysis session.

Leaving excess fluid and gaining excess fluid between each dialysis session is associated with an enlarged heart, repeated hospitalization and sudden death. In fact, it is the most common reason for repeated hospitalizations and is the greatest cause of death in a patient undergoing dialysis.

Therefore, even if your doctor has not prescribed more time, you should ask him for this. Though inconvenient, it allows a smoother dialysis session and greater length of life. 

The Importance of Good Foot Care

Question:

I was recently diagnosed with diabetes and my doctor told me that it’s important to take special care of my feet. Why?

Answer:

Vascular disease and diabetes can lead to many kinds of foot problems.  For some strange reason, we don’t like to talk about feet, we like to cover them up and not mention them to our doctors and nurses.  Perhaps the reason is that we can’t see our feet very well or because of nerve problems we don’t feel pain from developing complications.

Foot problems may be as common as athlete’s foot, or more complicated such as bunions and calluses, but as severe as superficial and especially deep and infected ulcers.  Unattended, this could even lead to amputation.  View Renal Ventures’ Foot Care for Everyone pamphlet for things to be aware of and watch for as well as proper foot care.

Do you have a question for our Experts? Submit a Question via email. Questions will be reviewed by a team of Renal Ventures medical professionals on a regular basis. Not all questions may be answered on the site, but we will try to respond in a timely manner.

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