Blood Pressures dropping significantly after 2 hours of being on dialysis

[hatedialysis2]

Hi, anyone know what can cause BP to drop by about <20pts (from 130's/70's to <100/50's) 2:30 + hours into treatment?      I am on nxstage 30 litres. 3 hours ten minutes, 60lbs, remove anywhere from .8litres to 2.2 litres per treatment, 4 days a week.   UF set at 1.   Is the treatment too long?    last time I took blood I had to cut treatment to 2 hours and 40 minutes because my BP was getting alarmingly low  and nothing helped ( i.e. saline...)  my kt/v came back 2.33 despite the fact that I cut my treatment time by 50 minutes.   I have cut down on my BP med significantly and only take  in the morning, 8-10 hours prior to dialyzing.   Any thoughts would be greatly appreciated!     I mentioned it to my nurse, he recommended I speak to my nephrologist whom I see this week.

[Hootie]

Here is an article that explains the relationship on UF rate and BP. Consistent with what dr Ager has said repeatedly.

http://www.homedialysis.org/life-at-home/articles/fluid-and-solute-removal-part-two

Based on my experience with my wife,  your UF rate is too high and according to article ...BP will drop at that rate. Article says the same thing.

I copied UF calculator to this site  a few days ago that might help.

[talker]

Hi, anyone know what can cause BP to drop by about <20pts (from 130's/70's to <100/50's) 2:30 + hours into treatment?      I am on nxstage 30 litres. 3 hours ten minutes, 60lbs, remove anywhere from .8litres to 2.2 litres per treatment, 4 days a week.   UF set at 1.   Is the treatment too long?    last time I took blood I had to cut treatment to 2 hours and 40 minutes because my BP was getting alarmingly low  and nothing helped ( i.e. saline...)  my kt/v came back 2.33 despite the fact that I cut my treatment time by 50 minutes.   I have cut down on my BP med significantly and only take  in the morning, 8-10 hours prior to dialyzing.   Any thoughts would be greatly appreciated!     I mentioned it to my nurse, he recommended I speak to my nephrologist whom I see this week.

Can only say how I coped/cope, with the low blood pressure events.
Also it was mostly after two hours that LB, would hit.
Now, I weigh my almost naked body at home each morning.
I now have a fair idea of what my average ideal 'dry' weight is.
Yes, I do look for any unusual swelling, indicating 'retention' is taking place.
The variance in real actual weight, establishes, 'How much' will be pulled out each dialysis session.
If I do  sense any LB event staring, I will take a half dropper of my home made 'red pepper 'tincture.
The LB pressure event will dissipate in around ten seconds. Yes, staff and neph are aware of what I do.
It works for me.

[cassandra]

When I do 2.30 hrs I take off 0.9 at the most. So UF is never higher than 0.35 otherwise my BP will crash. Just have to drink less the next day. Try the UF calculator from Hootie.

Good luck and love, Cas

[hatedialysis2]

Thank you Hootie, Talker, and Cassandra!

What I don't understand is why my bop crashed  2.30 hours into treatment when I was only removing one liter.  Did I miss something from the link you sent Hootie?  My UF would be 434.8 and at 400 refill rate the difference is small and should not have cause a crash.  My albumin was 4.2 that day, I know because I drew labs that same night.

Talker, when you mention red pepper tincture, are you talking cayenne?   My understanding is that cayenne dialates blood vessels and is taken to lowe blood pressure.  It's also a powerful blood thinner and has a lot of other miraculous health benefits.

[talker]

Thank you Hootie, Talker, and Cassandra!

What I don't understand is why my bop crashed  2.30 hours into treatment when I was only removing one liter.  Did I miss something from the link you sent Hootie?  My UF would be 434.8 and at 400 refill rate the difference is small and should not have cause a crash.  My albumin was 4.2 that day, I know because I drew labs that same night.

Talker, when you mention red pepper tincture, are you talking cayenne?   My understanding is that cayenne dialates blood vessels and is taken to lowe blood pressure.  It's also a powerful blood thinner and has a lot of other miraculous health benefits.

Yes is cayenne. It works both ways. Raises or lowers blood pressure, as ones body calls for.  I could write a small booklet on what my use of cayenne, has done for me. While I've never needed it for a heart attack, supposedly will STOP one within seconds. Have used it to stop severe bleeding doing yard work. I just pack the red pepper powder INTO the wound and continue doing what I was doing. Actually carry liquid and powder forms with me at all times Your words 'miraculous health benefits' more aptly describe how I use it. Do also put into capsules and use with some meals. Yup. used on an stomach it will give a very warm sensation. One does not just start using cayenne in a reckless fashion. Like I learnt to do, ingest with care at first. Eight of teaspoon or even less, until the body gets used to it. I can take a teaspoon full of low potential (50,000 / 100,000) HU units at a time, The really hot stuff , I would only dip my finger into it for internal use for starters. Even if told to stop using it, I would not comply.
http://www.thetalker.org/archives/100/97-latest-spicy-cancer-fighter/

[Hootie]

Typically what I read and been told...BP drops during treatment for one or two reasons.....(1) the UF Rate is too high and it shocks the system by taking fluids off too fast.
(2) The Total UF is too high for your dry weight. If you go past your dry weight, then you get too low on fluids and the BP drops. The #2 might be the reason after 2.5 hours.

The dry weight is a moving target depending on fluids retained, what you ate and when or even meals with a lot of salt. Our nephrologist and nurse has always been telling us that the dry weight is an estimate. If you have been eating more then it goes up. Appetite is a good thing for dialysis patients as long as you eat the right things and not too much over time.

We drop the UF rate when the BP starts to drop below 100. We use the calculator initially or estimate and drop to .4 or .3 when BP drops. At times after 10-20 minutes BP will start to rise again. I would talk to your nurse and go over your situation with her. Too many variables to assess on line. I am just giving you our experiences.

[hatedialysis2]

Tried cayenne in capsule form, but it seems to give me severe acid reflux.  so I lightly sprinkle on my food.  Thanks for the link, will check out later as I'm getting ready to end my dialysis treatment

[Charlie B53]

I am on PD, not Hemo,  so I don't have the same type of BP drops as you guys.  Mine are often due to fluid imbalance, (dry), of time of day taking my BP meds.

As I lost weight my med requirements also reduced, often leaving me with pressure drops until adjustment was made.

We did notice that time of day taking my lisinopril also made a difference.  I am now down to once a day, and switched to evenings as when taken mornings I still had occasional orthostatic drops.  I was surprised how that worked out.   I still take my metoprolol morning and evenings.  So far so go.  Will have to wait for Summer as the heat and humidity does drive my pressures up, additional body stress I suspect.

Point I hope may help is do not discount your regular meds, and how you take them.   Bp meds prior to treatment may contribute to BP drops.  If agreeable with your Neph, maybe stall taking that med until after treatment and see if that helps.

Take Care, 

Charlie B53

[Simon Dog]

You might want to ask your care team about using a lower UF.  If you are removing 2.2, you need to take 2.5 (rounding 277 up to 300) off over 3:10.   An UF of 0.8 would finish just a few minutes before your 3:10.   When you remove less than 2.2, you could use an even lower UF.

Using "1.0" only seems to be a shortcut designed to save you the trouble of floating point math.

[hatedialysis2]

Thank you Hootie, CB53, SD, Caass, and Talker for your valuable input and taking time to respond.  When I was trained on nxstage, I was taught to set the UF to 1 and that worked for the past 2.5 years.  Now that's not worked ny for me..  My team doesn't always have answers.  I usually have to give them suggestions as to what the cause might be and  possible solutions with documentation so from a reliable source,  So your feedback is invaluable.

[kickingandscreaming]

Yikes! It sounds like you need a degree in higher math to do HHD! I bow down before you all.

[Hootie]

Also, I would talk to your nephrologist on dosage for high blood pressure meds and timeliness  as our experience is that those two items could be a factor in BP dropping.

[Simon Dog]

Yikes! It sounds like you need a degree in higher math to do HHD! I bow down before you all.

The Fresenius Baby K handles UF more elegantly - you enter how much to take off and it runs the UF at a rate to use all your time rather than having the UF done "early".   The NxStage does it ass backwards and makes you type in a rate, leading to all sorts of sub-optimal shortcuts like "just enter 1".

Learn to do the match, and invest in a $5 calculator if necessary.