I have experinced very low blood pressure since starting daily dialysis in January 05. My high blood pressure dropped when I started hemo in 10/03 for 3 days a week. My blood pressure meds were discontinued then. But the very low pressure I have had for a year is getting in my way, low energy dizziness etc. I haven’t been to a cardiologist yet but I would be interested in what folks have expreienced since my doc throws up her hands. I cannot tell if I am logged on so that anyone will see this. I am desperate. I am thinking to change my time to five days a week with increased time on the machine per session.
I am in your same shoes as well! Same here, before daily-short…very high blood pressure BUT now my blood pressure is low…
I have spoken to other daily-short patients and they also are having that problem…
Seems that too much salt/sodium is beeing taken out!..
I also have found that consuming salty things like energy drinks, gatorade, or eating salty snacks helps to some point…give that a try…
I’ve had that problem since starting daily hemo, and I can assure everyone that I never had low blood pressure on dialysis before. I had it not so much on short daily (2 hours 6 days per week), but I wouldn’t expect that my severe hypertension would have been so easily resolved. Almost after the first day I started nocturnal (maybe a week, I don’t remember now), I no longer had high blood pressure, but within about 2 months, by my recollection, my BP when it got to my next treatment was too low (under 120, and then under 110). I’ve had to increase my dry weight a number of times since then (almost once a month, on the advice of my nurse and/or neph), gradually going from 56.5 kg originally to my current dry weight of 63 kg in street clothes. That’s a gain of about 14-15 lbs since June!
Unless a person were to be developing heart failure, which would lower BP, what seems to happen is this:
Daily hemo itself lowers BP more because the small arteries begin to relax more due to the better dialysis (all arteries are smooth muscle, so they can in fact relax). But what I think happens for many people is that, in addition to that effect, they can eat more and they do eat more – more liberal diet plus better appetite to eat it. So they gradually gain real weight. As you gain real weight and you keep target dry weight the same, more of your weight is real weight, and less is fluid weight. If you don’t gradually revise dry weight upwards, you end up trying to remove more and more fluid which isn’t there. So BP gets lower.
Even if that’s what is causing it, almost every former in-centre patient who switches to daily hemo is so well-trained not to eat salt that we don’t eat enough. Eat! Put the salt shaker back on the table. Start buying olives, pickles, etc. Eat cheese. Don’t be afraid to eat.
It’s not always obvious, but do you see visible signs of perhaps having gained some real weight? Do you feel any symptoms of being too dry after a treatment?
… but of course, you should check with your nurse or doctor first 
By the way, we’re talking BP between treatments. Low BP during treatments could also be a result of too much fluid/salt intake, resulting in having to take too much fluid off too fast.
Pierre
I wonder if your “dry weight” is too low. Dry weight is not something that anyone can ever really know, but it’s a weight that the staff estimates based on symptoms like blood pressure, cramping, and edema. Your dry weight will change as your appetite and eating change and if you have vomiting or diarrhea, etc. Sometimes people have felt so sick before starting dialysis that they had no appetite and lost weight. When they start dialysis (especially longer or more frequent dialysis) and get the uremic toxins out of their system, they start to eat better and their dry weight starts to climb. Be sure to tell the staff that if you’ve been eating more (or conversely if you’ve not been eating much and have had diarrhea). Reporting this should alert the staff to re-examine your dry weight.
thanks for the replies to my message. It is most helpful to find my position is not unique. I do not currently watch my salt intake because of the low pressure. But I am fearful of too much salt in foods because of general fluid retention. Dry weight has always been an issue for me as I am obese and have never suffered a lack of appetite. I have gained back about 8 lbs since starting daily dialysis. This is a combination of lack of exercise, trying not to take of too much fluid, and increasing salt/fluids.
Also does low pressure lead to increased clotting?
When your blood pressure is low it can increase your risk of clotting your access. This can also happen when your blood pressure drops too low during your dialysis treatment and if you become dehydrated. I’d ask the dialysis nurse about when a low blood pressure reading might lead to access clotting.
I have never been clear on what is a good bp to end tx with and how low is too low to clot an access. Personally, I have no low bp incidents when my ending bp is in the high 90s to teens and it seems good for me to take off every bit of fluid I can. I would not go any lower if I was symptomatic. I have never had a clotted access. Would be interested to know what bps others start tx with and what bps you feel comfortable ending up with?
Post-treatment, I’m perfectly happy with anything from 120 to 130 (sitting). Less than that and I think I would be a little worried about how low it might be getting during the night, since I’m not monitoring it and I don’t even wear the BP cuff overnight. Usually, by next treatment, my BP is still in the 120-135 range no matter what I’ve eaten.
Pierre
Hi Pierre,
I was referring to in-center txs. In-center as I put on fluid between txs it raises my bp to about 130’s-140’s coming into tx. I can see you are saying it is a different thing when it comes to nocturnal txs. One is getting the fluid off every night and so the bp is more stabilized.
My low blood pressure continues even with use of salt. This week I was prescribed mitrodrine. It has raised pressure a few number to 70 and 80 over 50’s and prevents deep, deep crashes after I eat(during digestion). I have also limited my daily dialysis to 5 days a week with a small increase in time each day. I will keep people posted on results. No further problem with clotting and getting good results from buttonhole, even pressures and nice cannulation channels. I continue to be hopeful 
I have posted in the past about my low b/p and high heart rate. It is still a problem for me. My standing b/p is usually around 74/47 and resting maybe 90/60. Heart rate ranges from 90s-130. I am currently awaiting a sleep study and after that they will refer me to a cardiologist.
I tend to have low sodium 128-132, and my carnitine is low which can cause low b/p so I am going to start taking carnitine as soon as I get the okay from my clinic.
What I hate about this low b/p and high heart rate is how tired it always makes me, I am hoping for some solution soon.
Cathy
Cathy, very interesting report on this…please keep us updated on this, perhaps other patients would benefit from this research…
Btw, have you already tried increasing your dry weight and adding extra salt to your diet?
I hope they find a solution for you soon, Cathy.
Like I said, since I started daily hemo, we’ve had to increase my dry weight by 6 kilograms. How do I know I’ve gained weight enough to increase my DW? Because I can see how my pre-treatment BP gradually slips below 120. At some point it becomes too low to dialyze safely, I call my nurse, and we raise my DW. My nephrologist confirms my DW goal is Ok at my next clinic appointment. She says this is very common.
Pierre
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Btw, have you already tried increasing your dry weight and adding extra salt to your diet?[/quote]
Yep, extra salt helps a bit, if I eat a “cup of noodles” every day I seem to do a bit better, but dry weight is not the issue. I’ve tried raising it, even significantly, but still have the problem, some days when my weight is the lowest b/p is the highest and vica versa. Even the neph and clinic finally agree that going too dry is not the problem.
Cathy
How is one tested to know if carnitine is too low? Aren’t all kidney patients carnitine deficient?
Yep, extra salt helps a bit, if I eat a “cup of noodles” every day I seem to do a bit better, but dry weight is not the issue. I’ve tried raising it, even significantly, but still have the problem, some days when my weight is the lowest b/p is the highest and vica versa. Even the neph and clinic finally agree that going too dry is not the problem.
Cathy[/quote]
Then maybe you should get used to eating salty soups and noodles everyday? Perhaps Chinese food, that’s very salty…
On the Carnitine side, if that’s low you should take supplements to get that up…
I have a question…
Currently, don’t you take any supplements at all? For example, Novasource nutritional beverage for dialysis patients…it has Carnitine in it…here’s a recap from an older thread…
http://www.homedialysis.org/boards/viewtopic.php?t=195&postdays=0&postorder=asc&highlight=novasource&start=18
Just curious if they have considered shortening your dialysis sessions or reducing the number of days to solve this low BP problem?
Pierre
Cathy wrote:
I’ve tried raising it, even significantly, but still have the problem, some days when my weight is the lowest b/p is the highest and vica versa. Even the neph and clinic finally agree that going too dry is not the problem
.
When you raised it how much did you raise it by?
Okay,
Carnitine, my carnitine was tested as part of the research project I am in. No one has mentioned it, and yes dialysis patients (kidney patients) are often deficient I have found in my research. So I have ordered a supplement and will take it with my center’s blessing. I do not take other supplements as I find no need, my last albumin was 4.4 and I do take kidney vitamins. I certainly can’t use any extra calories from a drink so I tend to stick to pills.
Dry weight, I have tried raising and lowering my dry weight by as much as 5 kilos, with the extra kilos I am short of breath indicating fluid overload, plus I get a bit of edema indicating that it is too high. Additionally, my heart rate and b/p have been great at the lowest and worst at the highest, and on another day just the opposite.
Less dialysis, I do believe there might be a correlation to dialysis as often after my day off my b/p and heart rate are great (not always but often), I am actually hopeful that possibly the change in machines will help. However, I believe that less dialysis is never better so am not interested in cutting sessions unless we determine that it definitely is the cause and nothing else can be done.
Thanks for all the suggestions, I really do appreciate it.
Cathy
I think more and longer dialysis is better, but I think there might be some limits we don’t know about. For example, I’m not sure my body could tolerate much more than 2 hours a day at the usual blood pump speeds. Now, on nocturnal, I do 7 hours, but it’s important to note that it runs much slower.
Pierre