I started home hemodialysis about 10 months ago and I’m concerned about shortness of breath that I’m having recently. I am trying to figure out a number for the amount of fluid I can safely remove in a run of dialysis. I found a formula that says under 10mL/kg/hour is safest but I tend to break medical formulas. I am 7 feet tall and my dry weight is approximately 173kg; I am about 25% overweight (my ideal weight as far as anyone can tell me would be about 135kg). Using this formula I calculate I can remove almost 7L of fluid in a 4 hour run and still be in the safest range for CV complications. I am currently removing a maximum of 4L in a 4 hour run but recently this doesn’t seem adequate as I have had to have several “catch-up” dialysis sessions to keep my fluid weight down. Does this formula work for me? If needed can I safely remove more than 4L during a run? I should add that I have high blood pressure that never goes low after HD.

Very large individuals, such as yourself, have a very hard time maintaining fluid balance with dialysis only three times per week.  While the formula that you mention is one that I also use, it may not be appropriate for large people.  For very large individuals, increasing the number of dialysis sessions per week may be necessary.  This can be accomplished with home hemodialysis.  I suggest that you discuss more frequent dialysis with your nephrologist.  With more frequent dialysis, it may be possible to bring your blood pressure down into the normal range.   In general, hourly fluid removal rates of less than 13 milliliters per kilogram of body weight per hour is safe from a heart point of view, but some individuals can tolerate more than this and others are unable to tolerate, leading to increases in the number of weekly dialysis sessions.

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