Can hypotension ruin my fistula?

[Desert Dancer]

Things have been going merrily along and I'd been feeling great up until about a month ago. Suddenly - and for no apparent reason - my blood pressure has dropped precipitously. I'm so dizzy I can barely stand most of the time and I'm overwhelmingly fatigued. I should also mention that I'm incredibly short of breath all the time - pre- and post-treatment - and had some jaw pain right about when this all started. I had a normal EKG and now I have an echocardiogram scheduled.

Naturally the first thing I did was raise my dry weight; it was 58 so I raised it to 60. No change. My clinic just said, "Oh, raise it to 60.5". Finally, after three weeks of meticulous record-keeping I was able to show them that it is NOT related to my dry weight. I deliberately fluid overloaded myself  - up to 67 kilos - AND stopped taking my atenolol for an entire week. Even at that weight and with no atenolol I was not able get my blood pressure to more than about 82/50. The only effect stopping the atenolol had was for my resting heart rate to go into the 130s/140s so obviously that's not the answer and the doctor had me re-start it.

My nephrologist started me on midodrine to raise my blood pressure almost two weeks ago. While taking midodrine you are not supposed to lie down because it can cause extreme hypertension; you are not supposed to take it within four hours of going to bed. Well, I just got up from an afternoon nap and my blood pressure is 77/40. I don't have and haven't had any symptoms of dehydration whatsoever... no cramping, skin on the back of my hand snaps back immediately, no thirst. It's getting so bad that I'm really beginning to be afraid to come off the machine by myself in the mornings.

But now another worry has occurred to me: can this hypotension screw up my fistula? I barely have a thrill anymore, just a really strong pulse. It doesn't sound right when I lay my arm on my pillow - it's sluggish. I haven't had any problems using it and my pressures on the machine haven't changed at all, but now I'm really freaked out that this low blood pressure is going to cause something more serious than just some dizziness.

Does anybody have any thoughts? Any at all as to what could be causing this or whether it could harm my fistula? Could the fistula be causing the problem? Has anyone else had unexplained hypotension? Help!

[amanda100wilson]

Jaw pain could perhaps be cramp?  When my blood pressure is low I get cramp to the left of my throat.  No cramp anywhere else just there.  I have also had BP issues in the past and I empathise with you on how tired it can make you feel.  Low BP can screw up a fistula, not sure why, Ithink that clotting becomes more of a risk.  What is your sodium level and other electrolytes?  Sorry I can't be more helpful

[Desert Dancer]

The jaw pain was more of a radiating pain, up my neck all the way into my cheekbone. It lasted for about four days.

All my labs are perfect. I KNEW low BP could screw up a fistula. Dammit.

[Desert Dancer]

Well, I'm officially on the verge of panic. My fistula's developed a loud wheezing noise.

[big777bill]

DD I know you said you had a normal EKG but with the jaw pain and low BP I would get to a good cardiologist and see what he has to say. Those are some bad symptoms, very indicative of heart problems. Maybe the echo will show more than the EKG. I will keep you in my prayers. God Bless, Bill

[kitkatz]

My BP has dropped this year significantly.  Docs do not know why. Not a lot of research out there on low BP.

[Whamo]

I don't know if this helps, but oxygen during dialysis helps mitigate cramps.  I pray you heal soon.   

[RenalSurvivorDotCA]

In answer to your question, yes. Hypotension can ruin your fistula. Low blood pressure means slower flow through the fistula leading to a danger of clotting.

From an access point of view, it's better to be slightly "wet" than to be slightly "dry". The balance is to not be too wet that you get into fluid overload. Most people can tolerate a 1/2 kilo-1 kilo over their dry weight without symptoms.

[kevinswife]

My husband has a graft that has clotted four times.  They have pretty much given up on his graft and are using a perma cath at the moment.  He has been having issues with low blood pressure.  He was so dizzy that he passed out at work last month.  His blood pressure was low (80 something over 50 something, I think).  He had a heart attack!  He didn't have any chest pain.  He just passed out for about one second.  Now he is wearing a defibrillator vest for the next month.  The plan is to do surgery to insert a defibrillator in his chest.  Let us know how the Echocardiogram turns out.  When are you having the test?  I hope everything works out okay for you. 

[Gandalf]

Wow, I am really glad you posted this question, because I have so very recently experienced something like that.  I have very bad hypotension generally, but on Saturday, during the middle of my dialysis session, I also was mowed down by acute vomiting and diarrhoea, so ended up 1.5kg below my dry weight.  I was pretty out of it for some hours afterwards,, but once I recovered sufficiently to look around, I noticed in absolute panic that my one hosepipe like fistula was flat and gone, with no bruit, just a pulse.  Next day was Easter, so could only return to Centre yesterday for them to look - it seems the very low BP actually silenced the fistula all together, and it cannot work any more........ tragedy!  I really was unaware that such a thing could happen!

[amanda100wilson]

The wheezing sounds,ike you may have a stenosis.