ICU patient on CRRT

My father is currently in the ICU on CRRT. Originally they said they planned to switch him over to Hemodialysis. Now they are saying his blood pressure is too low for it. Isn’t there a way to do Hemodialysis over more days for less time which would lessen the risk of lowered blood pressure?

Most people (and doctors) know about standard dialysis that is done three times a week for 3-4 hours per session. This type of dialysis requires fluid and wastes to be removed in 9-12 hours a week that healthy kidneys remove in 168 hours a week. It can be hard on patients, especially those with weak hearts. There are other ways of doing dialysis. Dialysis can be done every other day to avoid a 2-day gap or 4 or more times per week in shorter sessions. Dialysis can also be done over a longer time with dialysis machines set to remove less fluid per hour which is not as hard on the heart. Patients doing these extended treatments have fewer symptoms and feel better within minutes vs. hours after getting off dialysis compared to standard 3x/week dialysis. Longer dialysis is often done at home often while sleeping. Some dialysis clinics offer extended or “nocturnal dialysis” during a nighttime in-center shift.

Peritoneal dialysis is another type of dialysis that is gentler on the heart for those with low blood pressure. Doctors may not think to offer this for a patient who is already on hemodialysis. However, unless there is a good reason why he is not a candidate for PD, it’s worth asking about. PD is done at home after training. Most patients are able to do it without help, although help may be needed if your father has physical or mental limitations.

Kidney School has lots of information on various topics related to kidney disease. You can read about dialysis options in Module 2.

Home Dialysis Central has a “Find a Clinic” database that you can use to find dialysis clinics offering different types of treatment.

BTW, a medication called Midodrine has been used for years in dialysis patients with low blood pressure to raise blood pressure during dialysis. Here’s an article from 2004 that found it safe and effective.

I hope this information is helpful.

I’ll check it all out. Thank you!

He is already on Midodrine. The real issue is the hospital has this “standard” BP which they want patients to reach but his standard is much lower because he already has lower blood pressure. He is a paraplegic and is in bed almost all the time even when not hospitalized.

I’m trying to figure out what the absolute lowest a BP could be at while still able to do HD.

One question is whether they’ve trying to take off more fluid weight than he has on his body. Target weight is not easy to determine and sometimes dialysis staff try to determine this by seeing when a patient cramps or drops their BP. Doing this can stun the heart. In case they’ve not heard of this, you might let them know about the ultrafiltration calculator of the Home Dialysis Central site.

Here’s an article that might be of interest.

This one was written by a patient on home HD.

They are telling us now that he can’t do Home Hemodialysis while on Midodrine. Is that common?