Dialysis and Lasix

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I just have to ask this question. I think (hope) I know the answer but after asking around at work am not sure. Here goes.

I work LTC. I have an 85 year old female resident that has hemodialysis 3x week. She does not urinate. She is on Lasix, 30mg BID R/T CHF. In a person with normally functioning kidneys the fluid is excreted through urination, weeping etc. Well, this resident does not urinate and there is no weeping or any excess loss of fluid that I can see. So, my question is- Does the fluid come off in dialysis just like the other toxins that come off that accumulate from not urinating? She does not have any edema or other signs of fluid accumulation/loss. What happens to the fluid pulled off from the lasix in a dialysis patient?

Thank you for any help.

Linda

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A renal pt is on 30 mg BID???

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Yes, my renal pt is on Lasix 30mg BID. She isn't wheel chair bound so doesn't hide it in her sacral area. She's very trim, 5'8 and weighs 149 pounds. She only sleeps 2-4 hours at a time. She's "pleasantly confused" and wonders the facility most of the day/night (wears a wander guard). I haven't asked her dialysis nurse this question since I just started wondering about it myself the past few days. She has only been with us a short time and it just doesn't seem right. I will be in contact with her dialysis nurse first thing though.

Thanks for your help

Edited to add, she has been on dialysis for about two months now and has 15% kidney function.

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Specializes in CCU/CVU/ICU.
Yes, my renal pt is on Lasix 30mg BID. She isn't wheel chair bound so doesn't hide it in her sacral area. She's very trim, 5'8 and weighs 149 pounds. She only sleeps 2-4 hours at a time. She's "pleasantly confused" and wonders the facility most of the day/night (wears a wander guard). I haven't asked her dialysis nurse this question since I just started wondering about it myself the past few days. She has only been with us a short time and it just doesn't seem right. I will be in contact with her dialysis nurse first thing though.

Thanks for your help

Edited to add, she has been on dialysis for about two months now and has 15% kidney function.

If she's truly anuric (not making any urine) then the lasix is an oversight...and not needed.

If, as you say, she has '15% kidney function' then it can be assumed she makes SOME urine.In this case lasix could be beneficial in pulling fluid d/t chf/retention/etc (in conjunction w/dialysis), and may not neccesarily be an oversight.

OR...she was on lasix when she still had a documented '15% function' which has progressed to the point where she no longer makes urine...in which case it should be brought to a doc's attention cause it's not useful any longer.

Seems you have a wee puzzle on your hands ;)

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Specializes in CCU/CVU/ICU.
In my 4 years of traveling in 11 states I have seen patients taking lasix months and years into dialysis. As I said before I haven't asked the reasoning. But if it were my patient I'd certainly ask the dialysis nurse.

Yes, dialysis patients can be on lasix. However, if they ARE it's because they still make urine and the lasix is an adjunct to dialysis. The urine they make isnt 'good urine' in that it's not carrying waste-products or effective at maintaining electrolyte balance, etc... but it's still fluid. This is why lasix can be useful in CHF, retention, etc.

If the patient is TRULY anuric, lasix is of no benefit.

...like i said in my first post

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Yes, dialysis patients can be on lasix. However, if they ARE it's because they still make urine and the lasix is an adjunct to dialysis. The urine they make isnt 'good urine' in that it's not carrying waste-products or effective at maintaining electrolyte balance, etc... but it's still fluid. This is why lasix can be useful in CHF, retention, etc.

If the patient is TRULY anuric, lasix is of no benefit.

...like i said in my first post

Do you do dialysis? As I said I've seen patients put on lasix who were not making urine. I didn't ask the Nephrologist at the time. My bad.

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Specializes in CCU/CVU/ICU.
Do you do dialysis? As I said I've seen patients put on lasix who were not making urine. I didn't ask the Nephrologist at the time. My bad.

I'm not a dialysis nurse, however i do set up and run PRISMA machines (slow dialysis for critically sick/hemodynamically unstable patients). If you did indeed see a doctor put an anuric, chronic dialysis patient on a diurectic (lasix), you should have questioned him/her because it's quackery.

By the way, do YOU have ANY clue as to why something like that would be done? I'd rather not let this banter degenerate into a flaming match. BUt, as your name implies you're a dialysis nurse. It's troubling that you wouldn't know why a person that cant produce urine would be put on a diuretic (though you say you see it done). Lasix ONLY works if a person has functioning (urine producing) kidneys. If a patient has no kidneys, what (in your opinion, guess, etc.) would lasix possibly be doing for such a patient???

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Specializes in CCU/CVU/ICU.
And if she is not I still contend that the lasix is being used to hopefully regain kidney function..

That wont work. Lasix doesnt make non-functioning kidneys suddenly start.

The idea of 'jump starting' kidneys with lasix is a bad way of putting it. Sometimes, in patients with deteriorating kidney function, a doc may order a big dose of lasix in a last ditch attempt to pull fluid from a patient...and is usually a last gasp before initiating dialysis.(this practice can even CAUSE worsening renal function/failure) And, if a chronic dialysis patient is on lasix, it's because she still makes urine...even if it's not much (you'll see doses like 120mg bid or even higher in these people) ..it's not to help heal, jump-start, or improve kidney function...but rather to help pull fluid (whatever fluid is possible) from these people.

Do you HONESTLY believe anuric, chronic dialysis patients can spontaneously begin to make urine by using lasix? ...OR, does keeping an anuric patient on lasix (perpetually) help anything???

I'm sure your answer is 'no' and 'no'. In which case we agree and we can stop the back-and-forth.If your answer is 'yes', you're misinforming anyone who made read this post.

I think the answers to the OP's question can be found in the first few posts.

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Thanks for your replys everyone. She has dialysis tomorrow. I will definately be speaking the her dialysis nurse about the lasix. I'll update you when/if I find out anything.

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I've been following this thread. I found this online:

Once acute tubular necrosis develops, therapy is supportive. Drugs such as mannitol, loop diuretics, dopamine and calcium channel blockers have been somewhat successful in promoting diuresis in animals, but similar results have not been obtained in humans.

From this website:

http://www.aafp.org/afp/20000401/2077.html

Which I suppose may be why it's tried in certain instances.

I'll just go back to the observation tower now. :)

Amanda

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Sorry, I worked 2nd shift and just got home. I asked the dialysis nurse about this and she said "good question, I'll get back to you on that".:uhoh3: So I'm thinking you are correct and it was an oversight. But when she does "get back to me" i'll let you know how it goes. Thanks again.

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Ressurecting this thread.

Joined the forum to ask this same question bc we were also asking this question at work today. Wasn't my patient but a very similar situation where a patient stated they were totally anuric but was getting Lasix in betweek 2 units PRBC's. Must be an oversight by the renal doc...this patient is also on long term dialysis. Anyway glad to see that we were on the right track with our thinking!

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