Low Blood Pressure During Dialysis

[coldhoist]

I have been showing very low blood pressure during dialysis like 95/56 with a pulse of 52. It makes me feel weak and my body has spasms. None of the nurses seems to be too concerned about it. Should i be? When I leave dialysis I am weak as I can be. I am wiped out.. Is this normal and does anybody else have the same problem? What can be done about it? Thanks

[PrimeTimer]

You might ask if they can give you a little saline bolus or to turn off the UF (ultrafiltration) but to continue with the blood pump on to clean your blood. The bolus may have to be added back to your fluid intake numbers or rinse back number. If the problem with Low BP persists, particularly upon standing up after treatment, you might want to look into getting a prescription of Midodrine.

[Michael Murphy]

Awhile ago I was in the hospital with a dry weight of 130 kilos.  During a 1 week hospital stay while being treated for a GI bleed I was but on a broth only diet for four days and had gallons or water based laxatives poured into me.  I was released on a Saturday evening and went home. Around midnight I had to call a ambulance and be taken to the hospital again.  By Monday afternoon I went into Afib and passed out,  a code blue was called and as the crash cart arrived I began to jerk around the bed.  My ICD (internal cardiac defibrillator) fired three times and returned me back to normal rhythm.  The next day I was weighed at my insistence and I was at 138.5 kilos.  I began to begin to try to find my new dry weight.  I began pushing down by kilo per week.  Some where around 128 kilos my blood pressure would occasionally drop below 100,  I should have slowed my quest at that point put I pushed on taking for the first time medicine to raise my BP.  When I finally reached 120 kilos I left on a Friday and feli horrible all weekend. At that point i realized I had screwed up and I have been letting my dry weight drift up.  I am up to 125 kilos and I still feel good and I wii continue to drift up by .5 kilos a week.  The lesson is if your body is telling you something listen.  Low bp maybe you need to raise your dry weight.
Feet swelling maybe you need to lower your dry weight.

[Riki]

I've been having problems with low bp while on dialysis for months.  It seems to come and go, but it's sticking around this time.  They don't tend to tell me what the bottom number is (I can't read the screen because of it's coloring), but the top has gone as low as 77.  The issue for me is, I don't have any symptoms.  I don't cramp, I don't get lightheaded, still my bp is very low.  The issue I have with it is, if the bp is low, they will turn off the UF on the machine.  I have pulmonary hypertension, which is partially caused by excess fluid.  So, they stop pulling fluid, my bp doesn't go up, and I'm stuck with the fluid, making it hard for me to breathe.  The doctors have given an order for me to not turn off the UF on the machine unless the top number is below 90 or I have symptoms.  That's less stress for the nurses, but there doesn't seem to be any effort to find out why my bp is so low.  It's very frustrating.

[Hereware]

I can understand the frustration. Have you tried going somewhere else to ask?

[Michael Murphy]

My HP starts about 110 / 60 if it drops below 100 I have a midodrine prescription for 10 mg which I then take and my bp goes up.

[frugallyzing]

I hope you see a doctor and get a prescription addressing your concern. Anything regarding blood pressure should not be ignored.

[Riki]

I can understand the frustration. Have you tried going somewhere else to ask?

Where would I go?  I've talked to the doctors.  They know my issues.

[kristina]

Hello coldhoist and Riki,

I am very sorry about your trouble with low blood-pressure and have been trying to find something about it on the Internet and I am not sure whether this could help a little? I keep my fingers crossed and wish you both the best of luck from Kristina.

https://www.dpcedcenter.org/news-events/news/low-blood-pressure-intradialytic-hypotension/

[Qswee]

Helpful link. Thanks for sharing this.

[kitkatz]

One of the docs seems to think my low BP is related to adrenal gland function. Ask to see an endocrinologist.

[Riki]

One of the docs seems to think my low BP is related to adrenal gland function. Ask to see an endocrinologist.

I'll suggest that.  It would be another thing they could look into.  I already know that I have a leaky heart valve (there is a big technical name for it, but I don't remember what it is) and pulmonary hypertension, so I can't help but wonder if my low bp is somehow related to that.  I'm waiting to hear from a cardiologist.  I'm told that a referral has been sent.

[Hereware]

For most patients who experience a drop in blood pressure, small amounts of intravenous fluids are given.  Like normal saline given in a small bolus of 250 ml or so. In some cases, a medication called midodrine is used as a last resort.

[kitkatz]

Midodrine has become my before dialysis med. I take it before I got to dialysis to help my crazy low bp stay up.
I am dialyzing with a top number BP of between 80 to 100.

[kristina]

Hello Kitkatz,
Many thanks for the update and I do hope that with Midodrine your low blood pressure gets hopefully a "bit of spark"  and gets nicely under control.
I have always battled with high blood pressure and paid heavily for it on occasions ... who would have thought that the level of our blood pressure could be so threateningly life-important ... and I do hope your low blood-pressure is finally keeping nicely under better control and I wish you good luck and send my best wishes from Kristina.

[Riki]

I'm still waiting to hear from the cardiologist, though my bp seems to have regulated itself.  It is fine before I hook up and fine after I've got my blood back, but during the treatment, it seems to be staying above the 90, and some pressures are over the 100.  I'm okay with this.

I have a chest x-ray scheduled for November 22.  Hopefully after that, I can see the cardiologist (finally) and they may have some answers.  As a long term dialysis patient, issues are bound to turn up, but this is beyond ridiculous.