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?).

Interested in more discussions like this? Go to the Kidney & Bladder Support Group.

If it isn't one thing it is another! This morning Bill had me rub his hands and I noticed that the palm of his hands are red and seem to be slightly swollen. Also his stomach seems larger – extended – very soft to the touch – has been this way for awhile – only part of him showing overweight. When he is on his side it sags downward. Can these be CKD symtoms? Or normal and I just haven't noticed? Over the last couple of years he has gone from 230 to 180 without working on it. Sorry to be a bother but he doesn't want me to check with doctor and I'm just not sure what is happening or what to look for.

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Hi @billchitwood, I am sorry that Bill is dealing with so many issues. I thought I would share some information that may be helpful for you.

Low Diastolic Blood Pressure and Chronic Kidney Disease Are Associated With Increased Mortality: https://jamanetwork.com/journals/jama/article-abstract/1741818

Too-low diastolic blood pressure can be deadly for CKD patients: https://www.sciencedaily.com/releases/2013/08/130819185346.htm

Chronic kidney disease: https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-causes/syc-20354521

Have you asked his physician about his stomach being distended?

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He hasn't wanted to have me call his doctor – he already told him that he only wants palliative care if it comes to that. I just don't know what to expect or how to help him. Last blood test was mid November of last year. Thank you for the links.

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@billchitwood

If it isn't one thing it is another! This morning Bill had me rub his hands and I noticed that the palm of his hands are red and seem to be slightly swollen. Also his stomach seems larger – extended – very soft to the touch – has been this way for awhile – only part of him showing overweight. When he is on his side it sags downward. Can these be CKD symtoms? Or normal and I just haven't noticed? Over the last couple of years he has gone from 230 to 180 without working on it. Sorry to be a bother but he doesn't want me to check with doctor and I'm just not sure what is happening or what to look for.

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Hi @billchitwood
Red Palms can be an indication of Liver Disease. Do a search of “red palms” to read more.

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I did and it can also be related to low Thyroid. Some years ago he was put on med for low thyroid – just in the past year his blood test showed low TSH at .31 – so apparently the med isn't helping as much. When they did a knee reflex test on him he had no reaction in either knee. A few years ago was diagosed with a valve problem in his right leg. Treated for years for high BP, which was kept in a very good range, until recently when it has dropped, especially the diastolic. Also treated for gout, which he has suffered from since he was in his 30s, but now kept under control with med (actually no attacks after right hip replaced in 1999). Has always had sleep problems and taken sleeping pills. On anti-stress meds as well. Some confusion and often doesn't make it to the bathroom in time! Complete fatigue. Trip to and from the bathroom completely wipes him out and a shower is even worse. Seems like every day something new – now it is an itchy back. Has also had chronic back pain in the kidney area for some time. In the past two months has chronic diarrhea. Last blood test in Nov of last year showed him at GFR 55 while the one in July of 2020 showed GFR of 42.7 (likes to jump back and forth). Thank you for your help and just letting me ramble. Julie

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@billchitwood

He hasn't wanted to have me call his doctor – he already told him that he only wants palliative care if it comes to that. I just don't know what to expect or how to help him. Last blood test was mid November of last year. Thank you for the links.

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Hi, If Bill is interested in palliative care, I might suggest you inquire about a palliative care consult. Palliative care is not specific to end-of-life care. It is better name symptom management care. Clearly Bill is having symptoms that are related to his health conditions. A palliative care doctor or symptom management nurse can help.

Do you know how you might contact a palliative care specialist?

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I have no idea how one would find someone and gather that Medicare doesn't cover it (unless end of life). Sort of up in the air about everything.

At the moment we are keeping any pain under control. Stranges thing is how his Blood presure has dropped – today 114/53. Has been constantly low the past few weeks (wasn't really monitoring it before as meds keep it at a really good level. Thank you.

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@colleenyoung

Hi, If Bill is interested in palliative care, I might suggest you inquire about a palliative care consult. Palliative care is not specific to end-of-life care. It is better name symptom management care. Clearly Bill is having symptoms that are related to his health conditions. A palliative care doctor or symptom management nurse can help.

Do you know how you might contact a palliative care specialist?

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@colleenyoung I got so.e I formation I'd like to post in the Champion page IUCLAscientist found information for osteoporosis Silicon,along with LLysin ,Strontium but I don't know how to post it I have the article but again not sure of how to post it Can you help me with this information

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@lioness

@colleenyoung I got so.e I formation I'd like to post in the Champion page IUCLAscientist found information for osteoporosis Silicon,along with LLysin ,Strontium but I don't know how to post it I have the article but again not sure of how to post it Can you help me with this information

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Hi lioness,
Please post the information to the most appropriate osteoporosis discussions in the Bones, Joints & Muscles group (https://connect.mayoclinic.org/group/arthritis-and-joint-conditions-268850/)

Perhaps this discussion:
– Osteoporosis treatment or strontium citrate? https://connect.mayoclinic.org/discussion/osteoporosis-treatment-or-strontium-citrate/

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@billchitwood

I did and it can also be related to low Thyroid. Some years ago he was put on med for low thyroid – just in the past year his blood test showed low TSH at .31 – so apparently the med isn't helping as much. When they did a knee reflex test on him he had no reaction in either knee. A few years ago was diagosed with a valve problem in his right leg. Treated for years for high BP, which was kept in a very good range, until recently when it has dropped, especially the diastolic. Also treated for gout, which he has suffered from since he was in his 30s, but now kept under control with med (actually no attacks after right hip replaced in 1999). Has always had sleep problems and taken sleeping pills. On anti-stress meds as well. Some confusion and often doesn't make it to the bathroom in time! Complete fatigue. Trip to and from the bathroom completely wipes him out and a shower is even worse. Seems like every day something new – now it is an itchy back. Has also had chronic back pain in the kidney area for some time. In the past two months has chronic diarrhea. Last blood test in Nov of last year showed him at GFR 55 while the one in July of 2020 showed GFR of 42.7 (likes to jump back and forth). Thank you for your help and just letting me ramble. Julie

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His diastolic continues to be in the 59 to 44 range every day. He almost fell the other night (is using his walker a little more now). Admitted to having the 'wobblies'. The other morning showed 3 large red/purple purpura? on his rump with no idea how it happened. A normal large unexplained bruise on his arm. Would these be signs that the CKD is progressing? Or something else entirely? Again, he is resisting doctor visit.

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