My wife’s has a cough and short of breath after dialysis???

[mattie130]

My wife has had a lot of time consuming issues with the dialysis lately and I was just able to get back to your site. She has been on in-center dialysis for 18 months after a transplanted kidney quit working. She is on the machine for 4 hours three times a week. She developed what they said was pneumonia in February involving 2 ER visits and two different  sets of antibiotics over a six week period. The first was Zithromax with an IV at the hospital and six 250 MG caps to be taken 2 after each of the next 3 dialysis treatments. One month later she was back at the ER and they gave her Levaquin with a 750 MG cap and kept her overnight for observation then released her to take Levaquin 250 caps daily for five days. In each case her symptoms were difficulty breathing, burning in the front chest area and sore rib-cage. All of the major heart / lung testing and labs at the ER visits were OK and they had trouble seeing any fluid in her lungs. She was back at her GP doctor Tuesday and he said the pneumonia was gone. She had three quite good dialysis treatments this week. Her hemoglobin  was 10.6 and Oxygen reading was 97%.
The problem is she has felt lousy most of this week with the difficulty breathing, burning in the front chest area and sore rib-cage all back …. and a cough and fatigue. The GP said he thought it could be extra carbon dioxide in her blood / system and to try to slow down / control her breathing. The manager / nurse at the dialysis center said that her problem was not dialysis / ESRD related. She has been through a really complete physical work-up for a new Kidney TX over this same six week time period so we are quite sure that this isn’t a life threatening situation but very uncomfortable and troublesome. Really appreciate that you have this site and would welcome any comments on what we should do next.

[lmden]

My wife has had a lot of time consuming issues with the dialysis lately and I was just able to get back to your site. She has been on in-center dialysis for 18 months after a transplanted kidney quit working. She is on the machine for 4 hours three times a week. She developed what they said was pneumonia in February involving 2 ER visits and two different  sets of antibiotics over a six week period. The first was Zithromax with an IV at the hospital and six 250 MG caps to be taken 2 after each of the next 3 dialysis treatments. One month later she was back at the ER and they gave her Levaquin with a 750 MG cap and kept her overnight for observation then released her to take Levaquin 250 caps daily for five days. In each case her symptoms were difficulty breathing, burning in the front chest area and sore rib-cage. All of the major heart / lung testing and labs at the ER visits were OK and they had trouble seeing any fluid in her lungs. She was back at her GP doctor Tuesday and he said the pneumonia was gone. She had three quite good dialysis treatments this week. Her hemoglobin  was 10.6 and Oxygen reading was 97%.
The problem is she has felt lousy most of this week with the difficulty breathing, burning in the front chest area and sore rib-cage all back …. and a cough and fatigue. The GP said he thought it could be extra carbon dioxide in her blood / system and to try to slow down / control her breathing. The manager / nurse at the dialysis center said that her problem was not dialysis / ESRD related. She has been through a really complete physical work-up for a new Kidney TX over this same six week time period so we are quite sure that this isn’t a life threatening situation but very uncomfortable and troublesome. Really appreciate that you have this site and would welcome any comments on what we should do next.

Hi there i have only been on Heamodialysis for 3 weeks,. I do 4 hours 3 times a week, and for the first 3 hours i am fine but the last hour i start with a headache and tightness/pains in my chest. When i come off the machine and walk out of the center i do have a shortness of breath also. This lasts for about 3-4 hours after my dialysis. I don't get any other symptoms between sessions except aches/pains and cramp.

Sorry i can't be of much help!

[obsidianom]

My first question would be, what type of access is she using? Is it fistula or graft or catheter?
Any other medications and medical issues? What caused her kidney failure?  How much fluid are they taking off each session and how fast?

[mattie130]

Thanks so much for the responses. It’s really good to hear back from others.
Her access is a fistula in her lower left arm which she has had for many years …. installed prior to her original kidney transplant. She has no other health problems other that some squamous skin growths which she has had removed as needed. The daily meds she takes are: Sensipar 30MG to control high parathyroid hormone counts, Tenormin 25MG to control atrial fibrillation, Renvella binder 800MG four or five per day with meals and a Nephro kidney vitamin cap. She is given some Epogen and Iron at dialysis as well as a half normal dose of Heparin. It was never determined what caused her original kidney failure. They are taking  off 1.5 to 2 liters during each 4 hour treatment, I think quite steadily. Sometimes her blood pressure “crashes” and they have to take her off a little early. They run a Crit-Line once a week to monitor her dialysis treatment that day and she says that they always set the machine for “Profile 2”. Her main complaints are shortness of breath, cough, fatigue and lack of appetite with food sometimes causing nausea. She is in her early 70’s but in general says she is feeling much worse than the other patients in her unit …. even the older ones. Thanks again 

[obsidianom]

How long has she been taking atenolol (tenormin)?   Dose she take 25 mg every day ?

[jeannea]

How often does she see the nephrologist? I'm not sure that I believe the nurse that it can't be dialysis related. Are her problems all the time or are they worse after dialysis?

[mattie130]

She takes the brand name of actual tenormin and has for about 13 years at 25 mg per day. Originally they tried to switch her to the generic atenolol after about a year and she could not tolerate it. It made her agitated and kind of crazy. Actually a few years after that an assisted living facility put her mother on atenolol and her mother had a similar reaction, until they switched her off of it. We think that sometimes the generics are just not exactly the same. A Cardioligist put my wife on the tenormin after three episodes of arterial fibrillation to manage it.  Thanks ….. Mattie 130 ….

[mattie130]

She does see the nephrologist once or twice a month at dialysis or as needed. After dialysis she is fatigued and needs to rest for several  hours which we expect but she was having good days on the non-dialysis days until about three months ago. Now she is fatigued most to all of the time and the shortness of breath and cough comes and goes but is worse when she is lying down. She also has lost her appetite and after eating often feels nauseous.

[obsidianom]

I think she needs a GI consult. The cough and pain could be reflux or some irritation in the stomach and /or esophagus or GERD . Any time you have  stomach contents coming back up the esophagus it can trigger a cough. Also the pain in the back can also be from esophagus irritaion . Also the fact she feels worse lying down often indicates a stomach or esophagus issue. She could have an erosion or ulcer. The original pneumonia could possibly have been from this as an aspiration type pneumonia.
Bottom line, I would get her to a gastro enterologist and get worked up including possibly an endoscopy.  Do it as soon as possible.

[mattie130]

Thanks so much for the input. She has an appointment with her GP physician early next week. He is evaluating some heart & lung testing that was done on her by specialists and we will pursue your suggestions with him as well. We really appreciate the feedback from you           Mattie130