Hospital Dialysis, high blood pressure, headaches

Discussions for Patients, Family, and Friends HD For Patients
1

Hi Guys,

I mentioned something like this before here but maybe getting places - not fully yet though.

Again I am Cars Husband writing here - she is currently on Haemodialysis in hospital right now - three times a week. We have been into A&E for the last few days. From their further tests. Her BP has been up around the 200’s for the last two months and with it severe headaches. Finally light at end of tunnel yesterday - after a night in hospital [ thursday night ] they switched BP meds and introduced a Beta Blocker. At 6:30am friday morning they tested her BP - A perfect 140 over 90 for the first time in ages.

All was fine yesterday, all was fine today initially when she went on dialysis. But she texted me about an hour in to say her BP was back up to 180. So luckily the consultant is there. They are going to try take more fluid off, they reckon she may be ‘hiding’ it. She is 36 years old. We were told that it is easier to see fluid retention in older patients.

So - we thought it was licked, but no. Just writting this here to see if anyone else has had similar issues in the past and possible resolutions / causes.

I should say she has been trying for PD with a tenchoff recently added, the first one failed as it leaked, the new one added about 6 weeks ago.

Anyways, any info appreciated,

EDIT: Car got home, Bp was down to 157 when leaving Dialysis, headache subsiding. From this vantage point it seems something in Haemodialysis is causing the BP to go up, strange.

Cheers
Aidan

2

Hi Aidan,

We’re not doctors here (well, there are some doctors who read this–maybe they’d weigh in?), but IMHO, even a BP of 140/90–though better–is still troubling: that 90 is quite high. It’s unfortunately pretty common to have trouble controlling BP even with multiple meds when haemo (as you say ;-)) is only being done 3x/week. The ups and downs of fluid are quite hard on the heart and can, over time, cause heart damage. And your wife is only 36, so it’s important to break this cycle as soon as possible.

While she is doing haemo, perhaps she could ask for longer treatments? If she is doing 4 hours, getting 4.5 or 5 should allow water to be removed from her blood more easily and gently, which could help her BP. It’s curious that her BP has only been that high for the last 2 months. It sounds as if it would be worth asking the doctors to do some more checking into WHY it suddenly got so high. Did anything else change? (Other meds prescribed for other reasons, perhaps? A change in the water she drinks to one with more sodium in it?) In extreme cases they will sometimes surgically remove the kidneys to help lower the BP–though this is best avoided if possible, since the residual kidney function is important to have. However, BP that high puts your wife at risk for a stroke.

Hopefully being able to get going on PD will help with the BP, since it is a slower, gentler, more continuous type of treatment.

3

[quote=carodriscoll;14730]Hi Guys,

I mentioned something like this before here but maybe getting places - not fully yet though.

Again I am Cars Husband writing here - she is currently on Haemodialysis in hospital right now - three times a week. We have been into A&E for the last few days. From their further tests. Her BP has been up around the 200’s for the last two months and with it severe headaches. Finally light at end of tunnel yesterday - after a night in hospital [ thursday night ] they switched BP meds and introduced a Beta Blocker. At 6:30am friday morning they tested her BP - A perfect 140 over 90 for the first time in ages.

All was fine yesterday, all was fine today initially when she went on dialysis. But she texted me about an hour in to say her BP was back up to 180. So luckily the consultant is there. They are going to try take more fluid off, they reckon she may be ‘hiding’ it. She is 36 years old. We were told that it is easier to see fluid retention in older patients.

So - we thought it was licked, but no. Just writting this here to see if anyone else has had similar issues in the past and possible resolutions / causes.

I should say she has been trying for PD with a tenchoff recently added, the first one failed as it leaked, the new one added about 6 weeks ago.

Anyways, any info appreciated,

EDIT: Car got home, Bp was down to 157 when leaving Dialysis, headache subsiding. From this vantage point it seems something in Haemodialysis is causing the BP to go up, strange.

Cheers
Aidan[/quote]

Sorry its been frustrating for both of you, but based on my own experience the high blood pressure can occur from a failed cadaver kidney that has not been removed. Another cause is from can be from the original diseased kidney itself, sometimes they need to be removed…another cause could be from the re-use of dialyzers in the clinic.

Anyway, I think more frequent dialysis might help…it did for me. Before doing home dialysis Daily-Short 6x per week I use to have high blood pressure.

Meantime, be careful your wife is not adding any salt in her diet…

Take care, hope it works out for both of you…

4

Hi Guys,

Thanks for this info.

GUS - but based on my own experience the high blood pressure can occur from a failed cadaver kidney that has not been removed. Another cause is from can be from the original diseased kidney itself, sometimes they need to be removed…another cause could be from the re-use of dialyzers in the clinic.

Anyway, I think more frequent dialysis might help…it did for me.

She has had no Kidney Transplant yet, she is on the list though as of last July just gone. Yes - the original kidneys maybe, though she is not on a fluid allowance at the moment as her output is still very good. She has officially found that they do not re-use dialysers at the clinic.

She started Home Dialysis tonight again. As i said earlier she attempted this a few months back but the Tenchoff was put in wrong. It leaked. She had to have an op. to remove that and get a new one in at the opposite side. They then wait for 6 weeks to let it bed in. We are now at this point.

Earlier today her BP was at 180/100. After first fill tonight and before the first drain her BP was down to 144/88. She goes for HaemoDialysis again Monday night GMT at the clinic, they will do so for this week while breaking in the Home Dialysis. We will see if her BP goes up again at this and if headaches arrive. Her consultant is a bit baffled as to why the BP is going UP during dialysis at the clinic.

DORI SAID - A change in the water she drinks to one with more sodium in it?

For a very long time she has NOT drank tap water. Interestingly Tap Water here in Cork City Ireland has “Fluoridation to help prevent dental caries.” [ not sure what caries is, but thats what the site below said. Prevent dental decay maybe. ]

This is the bumph from Cork City Water works:

http://www.corkcorp.ie/ourservices/environment/watertreatmentworks/

An article about Flouridation concerns:

http://fluoridealert.org/news/1923.html [ Minister Martin was Minister for health ]

She is originally from Co. Waterford where the water is from natural wells, though I think they pump this too and add Chlorine.

The water she and I drink for years is bottled - exclusively EVIAN, lowest in Sodium we could find.

Thats the news so far. I decided to mention all this here as it may be useful to others in the future who may be travelling this rocky road.

Cheers
Aidan

5

Though this scenario is almost always a case of getting blood volume control right and is dependant on reducing blood volume through dialysis until the BP follows and comes down - at least initially with antihypertensive medication to assist - Dori is quite right that longer, gentler and more frequent dialysis is absolutely the key to better blood volume control and, through this, blood pressure control. I wont go into the benefits of long slow dialysis here - visit my website for that - but there is no question that control of blood pressure, salt and water balance and thirst all revolve around longer dialysis. Bernard Charra has shown us the way for 30+ years on this from Tassin in France.

There IS one oddity though - we see it occasionally in our younger patients on dialysis and your wife fits this group … paradoxical hypertension.

This is a strange but well-documented phenomenon - but it IS real. If you type the words … paradoxical hypertension dialysis … into your browser, you will find some papers from Kidney Intenational and one simple explanation at http://books.google.com/books?id=4iNZEwcuvL0C&pg=PA43&lpg=PA43&dq=paradoxical+hypertension+dialysis&source=web&ots=Dg1wozhIUk&sig=yO0tYRl2Wiy70-okAwpVgGNHDho which may help. It may be worth you discussing this with your nephrologist - though if her BP settles (which I suspect it will) on PD, then there may be little need.

John Agar
http://www.nocturnaldialysis.org

6

Hi there,
do not know if you find a solution to blood pressure issues ???
Here are the answer based on my own experience.
HIGH BLOOD PRESSURE ITS GENETIC !!! do not happen to anyone or for any other reason !!!
So for a moment forget that she is on dialysis just simply think its a hypertensive without having
kidney problems. This easy can be managed by taking EVERY DAY a medicines for her
high blood pressure.
Normally this can solved easily !!
NOW, she is on dialysis and imagine in 4 hours must hurry up to remove toxins, urea and many other
bad substances, INCLUDING THE HIGH BLOOD MEDICINES !!!
The machine cannot recognise them so in 2 to 3 hours all medicines are gone !!!
So, Blood pressure goes up again !!!
This problem CAN NOT BE SOLVED due to machine process, must change the way how they work
Good Luck

7

Not all high blood pressure is genetic. Sometimes it’s environmental or there are other causes. Here’s a CDC website about BP in families.
https://www.cdc.gov/bloodpressure/family_history.htm

Some blood pressure meds are dialyzed off while others are not. If you’re on dialysis and your blood pressure is not well controlled, talk with your doctor to find out whether the drug you take is dialyzed off, whether should take your BP medication before your dialysis treatment, and whether your target weight needs to be adjusted. Having a target weight that’s too high means there’s too much fluid in your system, which can increase blood pressure.

8

I usally return BP of around 140/75 after dialysis, but still have a headache, sometimes quite bad for maybe 4hrs after. It generally goes after a few hours sleep though.

9

I assume you’re doing hemodialysis. Headaches in people on dialysis can be caused by many things. This article lists several of the causes as well as how to manage the headache.

How much fluid are you trying to remove and what is the length of your dialysis treatment? Removing too much fluid too fast can stun and damage organs including the brain. If you can limit your fluid intake, that could help and check out the calculator and watch the video linked below to see if you think this might be the problem. If on the calculator, your fluid removal rate is in the red, that is the danger zone. Staying on dialysis longer to remove a safe amount of fluid per treatment may help. If the headache is causing you to have to sleep for a few hours, you might have more usable time making this change and if you don’t have a headache, your quality of life might be better.