Is Low Diastolic Blood Pressure common with Stage 3 or 4 CKD?

Posted by Julie Chitwood @billchitwood, Jul 29, 2021

Bill has CKD. Has been on Atenolol for decades and it has keep his BP at a great range. However, we recently noticed that his BP has been dropping really low sometimes during the day, especially the diastolic (in 50s, 40s, and one day 34 diastolic. Then later it will go back to fairly normal or at least 114/60. Is this common with Stage 3 or 4 CKD? He has also been suffering from chronic diarrhea lately (once or twice a day a couple of times a week). He is 88. Doesn't want to go to doctor and have more meds as he is already on 8 prescriptions and several OTC. Has been suffering from fatigue for several years that doctors indicate they can't do anything for. Has an enlarged prostate (which coud have brought on the kidney problem along with old age?).

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@mpeters

You are dealing with a lot. I will try to answer one of your questions. According to the Mayo Clinic site on Chronic Kidney Disease, retention of urine caused by prostate disease can lead to kidney problems. A relative of mine had this happen. After the prostate surgery his GFR went up some. I am holding you in my thoughts and prayers.

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He pees a LOT - all night long. Years ago he started using a bottle at night as he was getting up 6 or 8 times a night - high volume each time.

This morning he commented he has been getting cramps in his right calf, especially behind the right knee socket for about a week. He has had venous insufficiency for years now in that leg. Used to swell up but since he has his legs elevated constantly, not so much. But gets a lot of small ulcers on it. He also shows no knee jerk reaction in either leg.
Tough getting old!

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@markdeegan

Blood test every 3 months

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His doctor now has him on a 3 month follow up - I'm guessing he will do blood tests each time. He hasn't had him do a urine test so maybe I should suggest it. I have been doing the home dipstick test every so often. Each time show Specific Gravity at highest level. Some of the others are at either normal or lower or trace levels and hard for me to read (they don't match strip colors!). He has fun having me do his blood pressure, oxygen level and Kardia each day.

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@billchitwood

His doctor now has him on a 3 month follow up - I'm guessing he will do blood tests each time. He hasn't had him do a urine test so maybe I should suggest it. I have been doing the home dipstick test every so often. Each time show Specific Gravity at highest level. Some of the others are at either normal or lower or trace levels and hard for me to read (they don't match strip colors!). He has fun having me do his blood pressure, oxygen level and Kardia each day.

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Hydration

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In reply to @markdeegan "Hydration" + (show)
@markdeegan

He drinks a lot of water. Does try not to drink before going to bed or during the night (he used to). That helps slightly. Urine tends from medium yellow to dark yellow for the most part. At night he pees about a quart worth.

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Yesterday I went to the Renaissance Faire with daughter, son and DIL. DIL had us all dressed in costumes. It was a wonderful time, until I got home and Bill was furious that I had left him. Then he blamed the cat, saying I was terrible for leaving her as she missed me. That it was obvious that I didn't care about him but he could handle it unlike Lady Gray that had her furry little heart broken by my selfishness. That I should leave and go live with my kids and leave him to die alone. Lately he has been bringing that up for some unknown reason. Fortunately I know that if I don't respond he will get over it in a few hours if I have said I was sorry he got upset. Not easy being a caregiver!

This morning I discovered he had a very loose bout of the runs and, unfortunately, hadn't run fast enough. He is taking probiotics, which seem to be helping for the most part. Also this morning his BP was 105/58 and oxygen at 89. I'm not sure if that added to his upset with me last night or not.

He is back to his cereal diet. For about a week he was doing better with eating and feeling a little better.

At the moment his reasoning is I shouldn't leave him alone as he might have years left or only months. The doctor hasn't given any indication of life expectancy so he is just taking things out of thin air. In April he will turn 89. Currently at Stage 3b 44 GRF at last test. Considering everything he does enjoy most days. Not sure if the unreasonableness is connected to the CKD or something else.

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@billchitwood

Yesterday I went to the Renaissance Faire with daughter, son and DIL. DIL had us all dressed in costumes. It was a wonderful time, until I got home and Bill was furious that I had left him. Then he blamed the cat, saying I was terrible for leaving her as she missed me. That it was obvious that I didn't care about him but he could handle it unlike Lady Gray that had her furry little heart broken by my selfishness. That I should leave and go live with my kids and leave him to die alone. Lately he has been bringing that up for some unknown reason. Fortunately I know that if I don't respond he will get over it in a few hours if I have said I was sorry he got upset. Not easy being a caregiver!

This morning I discovered he had a very loose bout of the runs and, unfortunately, hadn't run fast enough. He is taking probiotics, which seem to be helping for the most part. Also this morning his BP was 105/58 and oxygen at 89. I'm not sure if that added to his upset with me last night or not.

He is back to his cereal diet. For about a week he was doing better with eating and feeling a little better.

At the moment his reasoning is I shouldn't leave him alone as he might have years left or only months. The doctor hasn't given any indication of life expectancy so he is just taking things out of thin air. In April he will turn 89. Currently at Stage 3b 44 GRF at last test. Considering everything he does enjoy most days. Not sure if the unreasonableness is connected to the CKD or something else.

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Oh Julie, being a caretaker is hard. Being a caretaker for an ungrateful or angry loved one feels impossible some days, doesn't it?
My guess is that the anger was because you weren't there when he needed you, made worse by low O2, which causes muddy thinking. And maybe a little sundowner syndrome - typical in dementia, where evenings are worse than days.

I can guess his response, but next time you are having a day or meal out, maybe you could offer to have someone come to visit while you are gone. That way, neither he nor Lady Gray will be lonely.

You are often in my thoughts, please continue to take care of yourself.
Sue

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@sueinmn

Oh Julie, being a caretaker is hard. Being a caretaker for an ungrateful or angry loved one feels impossible some days, doesn't it?
My guess is that the anger was because you weren't there when he needed you, made worse by low O2, which causes muddy thinking. And maybe a little sundowner syndrome - typical in dementia, where evenings are worse than days.

I can guess his response, but next time you are having a day or meal out, maybe you could offer to have someone come to visit while you are gone. That way, neither he nor Lady Gray will be lonely.

You are often in my thoughts, please continue to take care of yourself.
Sue

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He doesn't like anyone else here - no friends anymore as he always has an excuse. He has asked the kids not to come often or stay long as he isn't up to it. When they do visit, like recently from Vegas, he stays in his recliner and watches TV. Won't join us for meals and most definitely won't go out. He made fast work of the Home health people that our doctor set up. He always has been solitary inclined but now it is really bad.

But lately he has decided he should drive somewhere on his own. NO WAY! Not only driving not safe but he probably wouldn't find his way home and doesn't have an easy time with a phone. Like we couldn't get through to him yesterday. He does check his email but won't when I'm out so I can't reach him that way. And he probably wouldn't answer the door if I asked a neighbor to check on him. I think he wants to make it so there is no way I won't worry about him if I'm gone, which means short or limited trips. Game playing.

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@billchitwood

He doesn't like anyone else here - no friends anymore as he always has an excuse. He has asked the kids not to come often or stay long as he isn't up to it. When they do visit, like recently from Vegas, he stays in his recliner and watches TV. Won't join us for meals and most definitely won't go out. He made fast work of the Home health people that our doctor set up. He always has been solitary inclined but now it is really bad.

But lately he has decided he should drive somewhere on his own. NO WAY! Not only driving not safe but he probably wouldn't find his way home and doesn't have an easy time with a phone. Like we couldn't get through to him yesterday. He does check his email but won't when I'm out so I can't reach him that way. And he probably wouldn't answer the door if I asked a neighbor to check on him. I think he wants to make it so there is no way I won't worry about him if I'm gone, which means short or limited trips. Game playing.

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Julie, I hate to repeat, but yesterday proves that you are at the point where you and your kids need to make some HARD decisions, with or without Bill's participation. You think you are doing okay, but the two of you are one fall, illness or household accident from a serious problem, or more likely, an emergency decision. I wish I could sit beside you on the couch and talk about this, but that's not possible. I have been where you are, not as the spouse, but as daughter, sister, daughter-in-law, grand daughter, neighbor to a couple with no other family. Trust me, an uncomfortable transition with choices is better than an emergency transition. A few weeks of discomfort is better than you and the kids living with regret if something bad happens that you might have been able to avoid.

Explain your days and nights (completely & unedited) to the kids and have them help you make a plan and approach Bill with the options. Keep a journal for a week if you must - every accident, episode of unreasonable anger, full day of refusing food, liquids or medicine, night time wandering or wakefulness... First, read it yourself and see how many stresses, angry outbursts, hard decisions, interruptions and losses of rest you face every day and night. Then show it to the kids, and have a frank discussion. Put it like this "If I was fully unable to care for Dad tomorrow, and I needed help too, what would we do?"

Work together to make a specific plan to begin now, maybe regularly scheduled help from the kids or grandkids, or an agency. A way for you to rest at least a night or two a week without "one ear open", an agreement that Bill will allow someone to stay with him when you go out, so you don't have to worry. Maybe someone to do the laundry, shopping or cleaning so you can have a little sit down time, maybe a pharmacy that sets up both of your meds in blister packs so you don't need to mess with all those bottles - just follow the printed schedule... Then someone needs to explain that for both of you - either you (Julie) get regular, scheduled help & respite, or he needs to go to a care facility. Let Bill rage, growl, pout, whatever, and you can cry too, if it helps.

But please, don't wait for an emergency. I am worried about both of you.
Sue

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I will start the journal. Excellent idea. I do keep the kids updated pretty much. Using separate bedrooms has been a great help. I now am getting a full night's sleep. And I think he is actually sleeping better - at least if he isn't I don't know about it lol. Our kitty, Lady Gray, is actually very good about letting me know if he has a problem - a service cat? The last time he fell - onto the ottoman - she reacted faster than I did, sending out a cry as she raced to him. Our doctor is also aware as I type up notes for each time Bill has an appointment - noting things as they happen. I do need to note yesterday's problem. Thank you for being there! And all the other supporters.

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He has started talking in his sleep, which he never did before. He also called me outside because people were saying 'your sister is sick'. This happened several days last week. I heard a couple of birds chirping.

We accepted an offer on our home. Moving is so stressful!

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