dry weight assessment in hemo dialysis patients tirupathi- 2013

Dry Weight Assesment-2013

Dr.Siva Kumar, Avitum, 12th December 2013

Avitum | Dr.Siva Kumar | Dry Weight Assesment-2013 |

• Dry Weight Assessment Started : 14th September 2013.

• Pilot Project

• Better Results Expected

• We had to select better patients in whom probing of DW is easy

• Phases of Activity :

Phase I : Shortlisting the Patients

Phase II : Execution of Project

Phase III : Analyzing the results

• Project members in center : Dr. Siva Kumar, Dr. Bhargav, C. Pradeep Reddy &

Mahesh Babu.

Introduction


To Begin with…

• DW is the lowest weight at which patient does not develop intra dialytic hypotension & cramps

• Probing of DW is a trial & error method

• Coordination & Cooperation of the Patients plays a vital role in this programme

Example: Mr. X IDWG: 4kg Set UF : 4.5 kg Check for : Hypotension & cramps


So for better Participants… We formulated certain criteria


Based on the discussed criteria below listed patients were shortlisted

M. Devika A. Hari K. Gurrappa

E. Prabhakar G. Nagabhushanam Raju S. Usha Rani

Phase I: Shortlisting the Patients


Phase II: Execution of Programme

• Counseling on benefits of maintaining DW

• Diet Counseling

• AV Fistula Care and exercise

• Physical Exercises and hot water bath

• Extra Dialysis Sessions & increasing the Dialysis Duration

• Counseling the Patient attenders


Counseling regarding benefits of maintaining DW


Diet Counseling

1. Salt Restriction

2. Fluid Restriction & Thirst Controlling Measures

3. Low Phosphorous Food

4. Low Potassium

5. Protein Rich Food

Avitum | Dr.Siva Kumar | Dry Weight Assesment-2013 | Page

Salt Restriction

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High Salt Intake can lead to…

High BP Edema Cardio Vascular Diseases

Fatigue Insomnia ~ Sleeplessness


Fluid Restriction

Patients are always advised for taking water not more than…

Logic in the formula: Metabolic water in the body produced= 400mlWater lost through Respiration = 400mlWater lost through sweating = 400ml


Thirst Controlling Measures

Hard Candies Ice Cubes Gargling of water

Avoid exposure to hot & humid climate


Low Phosphorus Food

High Phosphorous diet can lead to…

• Bone & Teeth problems

• Hardening of Arteries

• Bone Pain

• Itching

• Decreased Calcium levels

Controlled intake of…

• Milk

• Cheese

• Yoghurt

• Ice-creams

• Dried beans

• Beer

• Colas

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Low Potassium Intake

Complications of High K+…

• Numbness

• Irregular heartbeat

• Paraesthesias

• Heart Failure

• Sudden Death

Complications of Low K+

• Cramps • Hypokalemic Periodic Paralysis• Tetany• Flaccid Paralysis

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Advice given…

• Avoid K+ rich fruits & vegetables

• Soaking & draining of Vegetables before cookling


Protien Rich Food

• Repeated Dialysis leads to loss of protien • Loss of protien can lead to PEM and loss of immunity• Loss of immunity leads to infection


AV Fistula Care & Excercises


Counseling Patient on AVF Exercise


AV Fistula Care Advices…

• Tight fitting garments

• Jewellery

• Weight Carrying

• BP Recordings

• Blood sample Collection

• Sleep position

• The better is your fistula functioning the more is the efficiency of Dialysis


Physical Exercises

Walking (2 miles/day) Cycling (5 miles/ day) Climbing Stairs 15min

Gardening (45min/day) Swimming & Water Aerobics (30 min)


When to avoid the excercises…

Chest Pain Irregular or Raphid heartbeat Leg cramps

Dizzy & light headed Fever & Joint problems


Hot water bath

2-3 times of Hot water bath/day on Non-Dialysis Days…


1. Extra Dialysis Sessions & increasing the Dialysis Duration We have provided the extra slots for the shortlisted patients and prolonged Dialysis durations at times whenever required.

2. Counseling the Patient Attenders

• Moral Support• Maintaining Diet principles• Ensure the patient performs the advised AVF Exercise


Monitoring of Patient at the center

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M. Devika( Detoriating) A. Hari (Reached DW) Gurrappa (Constant) Observation

Prabhakar (Detoriating) Nagabhushanam (Constant) S. Usha Rani (Improved)

Phase III : Analysis


Challenges Non Adherence to Counseling Very Low Urine Output

C H

R O N I

C

P A T I E

N TDepression Number of Anti- Hypertensive drugs


Co-Morbidities

CHF Obesity

Diabetes


Travel Expenses

Poverty

Rich Protein Food

Supplementary Medication


Un Education No Co-Operation From Attenders

Absenteeism Having Food & water during Dialysis


Attending Functions/ Parties

Poor AV Fistula Care Free Treatment


Weighing Machine Errors BP Recording Errors

Not Achieving the UF Goal


Proposal

Probing of DW assessment is possible in newly diagnosed CKD patients.

• Health Conscious

• No Depression

• More Co-Operation form Patient Attenders

• Less Co-Morbidities

• Better Urine Output

• Less number of Anti-Hypertensive Usage

• Adherence to Counseling

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WE HAVE THAT COURAGE…. WE’LL TAKE FORWARD THIS….!!!

“Success is not Final… Failure is not Fatal…

Finally Courage to Continue is what Matters”…!!!

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THANK YOU…

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