Preventing low blood pressure during dialysis treatment

[rcjordan]

I'm having trouble with repeated significant low blood pressure episodes while undergoing treatment (NxStage HHD).  Doing some research, I've found this

Preventing dialysis hypotension: a comparison of usual protective maneuvers. - PubMed - NCBI
https://www.ncbi.nlm.nih.gov/pubmed/11231376

CONCLUSION:
This study supports the use of sodium modeling as a first step in combating IH. Also effective were the use of cool-temperature dialysate and a high-sodium dialysate. All three test protocols were well tolerated.

Before I talk to my neph, has anyone here had any experience with any of these procedures?

[Alexysis]

Never go to dialysis on an empty stomach. This always works for me.

[rcjordan]

Nope, eating's not the cause in my case. I've been very methodical in testing to find when (and how much) to eat prior to treatment. Also, this isn't a weight-related issue as I'm at my dry weight and typically pull very little.

We can help boost my bp by removing my lap blanket or eating ice cubes, so I'm leaning toward the 'cool dialysate' method. I was hoping someone here had tried it. My Pureflow cabinet is currently set to 105F, I'm going to dial it back to 100F and give it a go.

[PrimeTimer]

Blood pump speed and the UF Rate might have something to do with it. Maybe give NextStage a call, they might be able to help. BTW, as food digests it can lower BP so may not affect you until late in treatment.

[SweetyPie]

Wow I thought I was the only one. My blood pressure during treatment will be steady in the 70's. The techs are just wow because i always say I am fine. I am not worried but my dad wants an answer why its low (hes afraid ill faint). Recently I started taking food and eating during treatment.... no difference at all. I wish I had an answer as well. Even thought its low im not sleepy. I really wish i could sleep during treatment

[rcjordan]

Well, it went so low (90/45) just before treatment last night during check-in that the NxStage app said "call the clinic." When we did, they said to abort the session and try again today.

[Michael Murphy]

Since my major heart attack I have had a problem with BP .  It has gone as low as 75 / 45.  Several steps have been taken to stop this, one I am on oxygen during dialysis, two I used to bring fruit to eat during dialysis now I eat before, food in stomach draws blood for digestion, three if my BP drops below 100 they stop taking off fluid, four if necessary I have a fourth session on Thursday.

[GA_DAWG]

That is what they do at our clinic Michael. If someone's pressure drops too low, they keep filtering but stop pulling fluid. When I first started, I had a problem with my pressure dropping in the last 30 minutes or so, and blacking out as a result. One of the techs figured out that they needed to stop adding the rinse to my goal because I gave up fluid easily. That ended the black outs, though I also learned that at the first sign of getting hot and breaking into a sweat, I needed to call someone. The blacking out is rather scary as it happens and you have no idea other than suddenly people are yelling at you and calling your name.

[rcjordan]

> blacking out is rather scary

It's scary to watch from across the aisle, too.  Over 3 months I saw 3 blackouts in my clinic. When someone blinks out, it's ALL HANDS ON DECK!!! to get the patient to come around.

I learned from those events and quizzed some long-timers.  A#1 signal seems to be feeling sweaty or flushed ...and you don't have much time to fix it.  Now that I'm doing HHD with my wife and no one to help her, I have to be doubly careful --which is why I'm asking here.

BTW, on my Pureflow heat setting 20 = 107f, 16 = 103f.  I'm currently running #16.

Also, I bought a $40 wrist monitor on Amazon that records BP every 10 minutes.  In early tests today, it appeared to be fairy accurate when compared to my clinic-calibrated cuff.  I'll post a link if it checks out.

[Charlie B53]

My worst pressure drops are on Mondays.  I suspect my dry weight is still a .5 K too low.  So by Monday they think I need to take off 3 K    I am fine until the last 15 minutes then I start to get very tight in my calves.  My pressures are fine until I stand up for that last reading, then it tanks, sometimes as low as low 80's.

I don't feel it.  No light-headedness, nothing abnormal, but my Nurse will make me wait another 15 minutes before she pulls my needles, wanting to see my BP at 100 or above first.

Many times the BP cuff will seem to have loosened a little bit during treatment, maybe my arm has shrunk slightly from the fluid removed.  Nurse will tighten the cuff then retake BP and most of the time that is all it takes and I will record 1Teens which is good enough to pass.

So far I've never gotten faint during treatments.  That only happens when I am bending over picking up the wind blown tree limbs in my yard.  And to think I used to spend money on dope to feel like that!

[GA_DAWG]

It's strange, but for whatever reason, my pressure goes up when I stand, though nearly everyone has theirs go down. Kind of figures mine would be backwards, like most everything else I do. I have learned, at the first sign of breaking a sweat to call for someone to return fluid. I'm with you rc, seeing someone go under is a scary thing, particularly if it takes them more than a second to get them back. I have seen it where they didn't and that is something I never thought I would sit and watch. The worst part is all you can do is sit there and pray. Sometimes it is answered.

[SweetyPie]

Im a odd case as well. About 30 or so minutes in now I am hot. If you feel my back its like its wet I sweat like crazy when I have soo much fluid on me. Its so weire last year I could barelt get warm dueing treatment now it different. My starting blood pressure is 82/50 after the weekend...
You all know about these blackouts. I never gotten one but but was well on my way. Scary feeling because you're delirious yet alert?
For those who have experienced it what usually happens? How are you able to get back up, im guessing saline?
Another thing, today my nurse did not add rinse back all though hot the whole treatment It went easy. I was able to pull 1.7. What does not adding rinse back do? I dont get it

[lulu836]

It's strange, but for whatever reason, my pressure goes up when I stand, though nearly everyone has theirs go down.\

I am the same way!  Nurses say that I'm built upside down.

[Charlie B53]

If I understand correctly the Rinse Back is figured to replace the blood lost in the machine lines.

.5K generally.  Though they try to return all of our blood there are traces left in the lines and filter, thus adding that amount of saline, hopeing not to leave us too low of total fluid volume which can drop BP's.

[kitkatz]

I, too, am built backwards.  My BP goes up when I sit up and stand up.   The dialysis doctors says I have weird cycles with my BP of ups and downs, mostly downs now.  I am on one midodrine every dialysis day.

[Charlie B53]

Monday, once again I came in far heavier than my usual.  If fact, today was a new record high for me.  3.7 over.  I asked if we could only take 3 with NO rinse back and see how dry I can keep myself until Wednesday, then take off any remaining.

So keeping that extra .7 on today for the first time my standing BP was over 100. 

It was like  Whoo Hoo!   Cause she didn't have to retighten the BP Cuff or make me wait a few minutes for my pressure to come up.


Like I told her before, I suspect we have my dry weight just a half too low.   Will have to wait and see what Wed brings.

[rcjordan]

We've lowered the heat setting on the Pureflow to 14, which keeps the dialysate at 100f. My low BP issues are doing better.

[Charlie B53]

Somehow treatments cause me to eat.  I don't know if the machine drops my blood sugar making me hungry or what, but I drive through McD's and get their 2fer breakfast deal, two buscuits, bacon, egg and cheese.   The rest of treatment I suck on Lifesavers.

One Nurse tried to tell me the blood flow to the intestines increases, most likely contributing to my blood pressure drops standing after treatment.


They much rather see us starving hungry during treatment and eating after we get home.   I think.

[SweetyPie]

I go crazy after treatment also!! I feel like a mini monster. Like i am hungry and no matter what my tummy doesn't get full. Its crazy. After than i knock out haha

[Riki]

CONCLUSION:
This study supports the use of sodium modeling as a first step in combating IH. Also effective were the use of cool-temperature dialysate and a high-sodium dialysate. All three test protocols were well tolerated.

I'm not sure what sodium modeling is, but we have tried cooling the dialysate and high-sodium dialysate.  Neither of them really worked for me.  Like Kitkatz, my bp goes up and down in stages.  I can go a while with it being incredibly high, to a point where it needs to be medicated, then it will drop down and I need extra measures in order to go home after treatment.  I haven't had any really high bps in a long time, and they were fairly steady for the longest time, but in the last 3 or 4 treatments, it's gone down again.  It stays somewhere around 95/50, until I stand at the end of the treatment, and it goes back up again.  It seems to go up as soon as I'm connected to the machine, and goes back up as soon as my blood is back.

I found that with the temperature of the dialysate cooled, I froze during treatment.  I now have an order for it to be set half a degree below my pre-treatment body temperature, and it's helped a bit.  For the nurses' piece of mind, I let them set the machine to stop pulling for the last half hour of treatment.  I haven't seen it make much of a difference, but it makes them feel better. *G*

Our unit has Fresinius 5008 machines that have the UF control setting, which I love.  The machine can sense if it needs to pull more or pull less, once your critical level has been figured out.  Mine hasn't been yet, but it was pulling more than I normally allow the nurses to take, and I felt fine leaving.  The only issue now is that my bp is low, even though I have symptoms.  I did have an order that allowed me to leave as long as I had no symptoms and my bp was above 90, but I think that order may have expired.

[kitkatz]

I am sliding back into the low BP phase of my cycle.  Sigh.  It has been almost normal for the last few months.

[Michael Murphy]

The mistake I have seen newbies make is wearing drastically different sets of clothing.  Remember if you wear a kilo more when you are weighed then a extra kilo is removed in fluid.   Plus if you gain weight then the new extra weight will be removed as fluid causing your BP to drop.  My theory is if they are removing the appropriate level of fluid and my BP drops that’s my new dry weight.