Low Blood Pressure at end of Treatment

This is from an old post (from December 2010) by M3Riddler but think it's worth being re-posted. I think M3Riddler explained why some people experience low bp during treatment very well.

Re: button hole problems with low blood pressure at end of treatment
« Reply #6 on: December 24, 2010, 06:31:37 AM »
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sbrown,

This is very common for in-center dialysis. What is more than likely happening is that they are removing too much fluid too fast. This not only causes blood pressures problems, but is very stressful on the heart. The in-center approach to this is to give you more fluid.... Now, you have just been sitting there for a 3 hour treatment to remove fluid ( and toxins) and they give you more fluid at the end of treatment.... What sense does this make... It is like a roller coaster ride....
When you remove too much fluid or remove fluid too fast, the bodys response is for the blood pressure to drop. You may also feel nauseated and have a sick feeling for several hours. You may also experience head ache.
There are three compartments in which fluid resides and must pass in order for it to be removed in dialysis. It goes from the tissues of the body - to cells - to bloodstream. When it reaches the bloodstream, this is what is being removed by dialysis.
Problem: The body is only capable of removing a certain amount of fluid per hour since the bloodstream can only hold a certain amount... This amount is approx .400cc's (.4L) give or take a few hundred cc's per each individual depending on weight/height etc. So lets say it is 600cc's or .6L. If they are taking more than that off per hour, or lets say 1800cc's ( 1.8Liters) per treatment, then you may get the washed out horrible feeling. You are stressing not only the heart, but also your fistula/veins. It takes approx 1 hour for the fluid to move from one compartment to another in the body.

I have been in-center and most people after their day off, are removing much more than the 1.8 Liters per treatment. They can remove as much as 5 liters or more in a 3 or 4 hour treatment. This is stressing the heart entirely too much.

For all of those in-center -
Also, with in-center, they are running people at entirely too high of blood flows. Sometimes 5-600 pump speed. This also can cause issues with your fistula/heart. The reason they do this is that they are required by CMS for you to reach a certain KT/v each month. Since you are only there for 3 or 4 hours every other day, they must crank up the blood flow to each this goal.
The fact is that more dialysis and slower dialysis is much better for you. It is gentler on the body, and removes more of the toxins from the body. No head aches, no washed out feeling, no bp drops.
The aggrevating thing is, the nephrologists know this. So why do they not offer it to in-center patients...The answer is, they must get you out in order for them to get the next patient in. Most in-center patients are not receiving opticmal dialysis, but rather adequate and sometimes not even that.
Nost in-center patients will not question their nephrologist but rather take their word as what goes.... So for your own health, ask your nephrologists - ask them if the nausea, bp drops and washed out feeling is related to the high blood flows and pulling too much fluid off too quickly.....
Research dialysis and how the settings affect you..... Do you want adequate just getting you by or do you want optimal?
Is home dialysis possible for you?