BP Rises Upon Standing After Treatment

[PrimeTimer]

Sometimes my husband's BP shoots up upon standing for his final BP reading after treatment. It always goes back to normal but this sudden rise drives us both crazy. I want him to bring this up with his neph. Wonder how common this really is and what if anything, can be done about it.

Bruce (Xplantdad) was kind enough to share this link with me, which may explain things. It's about Intradialytic Hypertension.
 
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2830363/


Here's some facts about my husband: he's Diabetic -Insulin dependent, been on home-hemo dialysis over 2 years, 5xweek, takes meds for high BP and EPO twice a week.


Sorry, meant to add that I think I read that the Vagus Nerve may also play a role in the rise and/or fall of BP at the end of treatment. 

[Charlie B53]

That paper is quite a read. 

Rising BP is not to be taken lightly, especially when the numbers get much greater than a normal high.   There must be a reason.

I am on PD.  I take my BP both sitting and standing morning and night.   There are a few days when I notice my standing numbers slightly higher than sitting, and I pause to wonder the cause each time.   About the only thing I have noticed is my weight is slightly higher on those mornings.  PD did not take off so much during the night.  Then I wonder why?  Was my blood sugar higher?  No, I test every morning.  I end up blaming my diet, the hidden salts that cause me to hold more water for almost a week, until that extra salt is dialysed, or removed by the small amount of urine I still produce.   Whichever it is I think it is the additional water overload that causes the higher standing BP.

I noticed in the paper there is mention of challenging dry weight.  It may be a possibility that your Husband has lost mass but the water is remaining, making his weight remain the same but possibly causing or contributing to his BP's.

Not being a Dr I cannot advise you do anything except proceed with all due caution.

Watch his legs, etc., for any signs of hidden water.   Lot his Dr know immediately if you notice anything.

Take Care,

Charlie B53

[Fabkiwi06]

Document, document, document. How often is it happening, what were the treatment stats of the last session, how recently did he take his meds, how long does it take to go back to "normal", how much over "normal" is it? As much info as you can provide to your team.

My experience is similar to Charlie's - sometimes it's higher for me and it's usually after an unusually low UF night. I usually cut my fluids down and get super strict with the diet until it's back to my normal levels.

[PrimeTimer]

Okay, so ended rinseback early 3 times now and all 3 times his standing BP readings are lower than they've been. A LOT LOWER. I rinse the tubing until they run clear or pale pink and then stop. I don't continue giving him the remainder of saline that is left in the bag. I am still able to get his final numbers (total BLP, UF removed, treatment time, Dialysate amount) so stopping the cycler early doesn't seem to affect stored data. I still want him to bring this up with his neph and ask about intradialyctic hypertension and how to avoid it (lower sodium, calcium, fluid, etc) And I want to know as to whether or not ending his rinsebacks early is harmful or good in the longrun. If he asks his neph about it and gets back to me on it, then I will surely post about it here. Thanks all for your patience. 

[Xplantdad]

Very interesting! Please let us know what you find out. Holly continues to have one standing blood pressure right after treatment that is high....5 minutes later it's okay?

[PrimeTimer]

For 3 consecutive treatments I have manually stopped rinseback slightly early and his standing BP is LOWER! Before pressing "stop" I made sure the blood tubing was running clear so that he got back his blood. I still want him to bring all this up with his Neph and Intradialytic Hypertension, which from my understanding could be caused by fluid overload and/or not removing enough fluid and sodium and calcium levels, among other factors. Meanwhile, very interesting how his BP went down with a shortened rinseback.

Anyone know if a lower rinseback setting on NxStage means a shorter rinseback time or does it mean less fluid being rinsed back? 

[Charlie B53]

I'm glad you found a method to manage treatment without getting those high pressures.

We are not all the same.   What may be fine for some can be seriously dangerous for another.

You've done well.

[Xplantdad]

For 3 consecutive treatments I have manually stopped rinseback slightly early and his standing BP is LOWER! Before pressing "stop" I made sure the blood tubing was running clear so that he got back his blood. I still want him to bring all this up with his Neph and Intradialytic Hypertension, which from my understanding could be caused by fluid overload and/or not removing enough fluid and sodium and calcium levels, among other factors. Meanwhile, very interesting how his BP went down with a shortened rinseback.

Anyone know if a lower rinseback setting on NxStage means a shorter rinseback time or does it mean less fluid being rinsed back?

I will email the local NXStage rep and find out

[PrimeTimer]

The fourth time I stopped rinseback early I also took his "standing" BP sooner than the 3 other treatments. BP went up. Not as high as previous treatments but nonetheless, it went up. What I failed to mention before was that the 3 times I previously stopped his rinseback early we also sat and rested about a minute or two before having him stand up. A shorter rinseback followed by a very brief rest probably contributed to a lower BP. I wanted him to bring this up with his Neph but he didn't/hasn't yet. Of course, she sees our weekly treatment log sheets which include my notes and all his BP readings but has said nothing. Or if she has, I don't know about it. Anyways, I think he probably has a little more fluid on-board than we (I) know of. Gotta get that off.

[Charlie B53]

Even on PD it is often difficult for me to get rid of excess fluid.  I have to make a serious effort to try to limit my intake.

I don't doubt you are trying to do this already.  With the hot humid weather we are having here in the mid-West this is very difficult not to keep a tall glass of ice water at hand.

Because my kidneys still make some urine Dr has me on massive lasix plus metalazone to help keep the kidneys making as much as possible.  It really isn't that much.  Far less than a liter/day.   Maybe I should try harder not to drink so much ice water?

I also sweat seemingly buckets.

[PrimeTimer]

Even on PD it is often difficult for me to get rid of excess fluid.  I have to make a serious effort to try to limit my intake.

I don't doubt you are trying to do this already.  With the hot humid weather we are having here in the mid-West this is very difficult not to keep a tall glass of ice water at hand.

Because my kidneys still make some urine Dr has me on massive lasix plus metalazone to help keep the kidneys making as much as possible.  It really isn't that much.  Far less than a liter/day.   Maybe I should try harder not to drink so much ice water?

I also sweat seemingly buckets.

Funny you mention sweating. My husband hardly sweated before he started dialysis, that always worried me. He said it was because of his Diabetes. Didn't seem normal. Now he sweats but then of course, he's dehydrated. His job takes him outdoors a lot in the hot sun and he use to carry a water bottle with him but he doesn't anymore. He limits his fluid intake and if he's still thirsty he sucks on ice cubes. I suspect salt/sodium are the culprits. He use to be on Lasix but Neph took him off once he started dialysis.

[Charlie B53]

I often worry about my electrolytes becoming out of balance sweating as I do.

Gatorade and pedeolyte are drinks I think I should consider. But I drink water.   PD allows me much more leeway in fluid intake.

I've asked my Nurse and Neph if there is anything I should be taking.  I've never gotten a straight answer other than my labs are fine.   Keep taking the Renal Vitamin.

I'm sure sweat can be an issue.  Some days I've lost almost two pounds from morning to night.  And that is even drinking my ice water.  Many of those nights I regain some of that weight by morning.  Whether it is from PD or the fluid I drink at dinner and my morning coffee, I don't know.  It is always a surprise when it happens.