Revising Target Weight: A Personal Account

Formerly known as "dry weight," target weight is today preferred, and indicates your weight at which the amount of fluid in your cells, in the spaces surrounding your cells, and in your blood vessels is at its optimum. See: A Primer on Haemodialysis "Weight" - Home Dialysis Central. For an in-depth account of the difficulties we experience both at home and in the clinic, see: The Elusive Dry Weight: A Dialyzor's Lessons Learned - Home Dialysis Central.

The goal is to attain your target weight by the close of each dialysis session, achieving this by adjusting your ultrafiltration (UF) amount to match your weight gain since the previous dialysis. People with healthy kidneys are always at their target weight-indicating the marvelous job done by these small organs.

Blood Pressure and Target Weight

BP is a vital factor pointing the way to determining and maintaining your target weight. If insufficient fluid is removed by the kidneys, the blood vessels experience too great a volume of fluid, so blood pressure increases. For most people, BP at the close of a dialysis session serves as the indicator whether one's UF goal (based on regaining your target weight) is accurate. BP should be what your GP considers normal for you, though repeatedly we hear of dialysis patients "everyone is different," and we should note that the unnatural process of dialysis impacts people differently. For some, blood pressure only reaches "normal" some hours later.

4 Years of Zero Weight Gain

My own kidneys maintained optimal fluid balance for 4 years after starting hemodialysis, and accordingly I experienced zero interdialytic weight gain. Then, my urine volume dropped quite suddenly to 0.4L/24 hours and I adjusted the UF goal accordingly. Difficulties set in shortly after I contracted shingles. The disease attacked my right eye. I spent some days in hospital, where complications were discovered, and was put on a range of debilitating medications. These crushed my appetite and I lost 9 Kg (58 down to 49) in the space of a few weeks.

Re-setting Target Weight

The meds played havoc with my memory, balance, and coherency. Some weeks later, I threw out the meds, regained my appetite and energy, and thankfully began to put on weight-unaware that the gain was primarily a steady gain in fluid. A corresponding rise in BP, I attributed (unwisely) to tense times and the stress of neuralgia.

My dialysis nurse cautioned me against this assumption and examined my legs, particularly the flesh just inside the median line down the shin bones. Pressing down with her thumb, she noted that the indentation on the flesh remained for several seconds even after the thumb was removed-a sure sign of excess fluid in the tissues. (In severe cases, the same is true for ankle flesh.) She suggested that I drop my target weight from 54 kg to 53 kg. This I did, and noted a slight drop in BP. A further reduction to 52 kg restored normal blood pressure. Confirmation of no excess fluid was gained by repeating the "shin flesh" test.

Currently, my interdialytic weight gain is around 1.8 kg and to compensate for re-infusion at the close of dialysis I set my UF goal at 2L. Dialysing for 4 hours, this is an ultrafiltration rate of 9.3ml/kg/hour which is OK, though at the upper end of safe removal rate. Ultrafiltration Rate Calculator (UFR) - Home Dialysis Central.