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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@gingerw

@billchitwood While you have the time, write down the differences you have seen, the increased safety issues, and how it all affects both your daily life, and your husband's. I have found it so much easier to do when my mind is not grasping at things being said in a dr office! You can refer to your notes and answer questions in a semi-logical manner, then.

As @sueinmn said, the medication may be playing a big part. If he has lost weight, but still on the same dose, his dr may very well want to change that dose. That would be a typical response. I have heard of diabetic and high blood pressure patients alike, losing weight and greatly reducing their medication list. Be sure to question the dr about the safety railings, also, and how you can make your house an easier-to-navigate environment.
Ginger

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I have a chart of his blood pressure and pulse - with notes of which days he suffered from diarrhea and/or other un-normal days. Also did another chart of all his symptoms, etc. Typed as I have terrible handwriting and spelling (oh, I do so love spell check!).

I was thinking of mailing a copy to the doctor before calling for an appointment, which would give him time to look at it before hand. Didn't know if that is proper or not.

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@billchitwood

Sue, as of mid November he will have been on Cholesterol medication (he had shot up from normal to 209) for a year. I'm guessing the doctor will want to check it so either his office will call or I'll call and set him up (he finally said that would be ok as he is hoping the doctor will take him off medications! He dreams a lot.) Tuesday Mayo is deciding if I get a Cochlear Implant so I need to see when it will be so I can get Bill scheduled. He is no longer up to driving.

I was wondering if the Atenolol needed to be adjusted or stopped. He has been taking it since about 1990 and kept his BP at a perfect range as well as his pulse.

Now trying to figure out a way to get him off the toilet seat - the safety railings are no longer enough and he weighs close to 100 pounds over me since he lost weight - he is almost a head taller as well!

Thank you for your help and suggestion. Julie

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@billchitwood While you have the time, write down the differences you have seen, the increased safety issues, and how it all affects both your daily life, and your husband's. I have found it so much easier to do when my mind is not grasping at things being said in a dr office! You can refer to your notes and answer questions in a semi-logical manner, then.

As @sueinmn said, the medication may be playing a big part. If he has lost weight, but still on the same dose, his dr may very well want to change that dose. That would be a typical response. I have heard of diabetic and high blood pressure patients alike, losing weight and greatly reducing their medication list. Be sure to question the dr about the safety railings, also, and how you can make your house an easier-to-navigate environment.
Ginger

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Julie, if he has any upper body strength, but the angle of grab bars is wrong, there is an device with overhead grab bag like a trapeze. Also, are you using a toilet seat riser - 3", 5", even 6". Also some have attached grab bars that might be easier to use.

Do you use a transfer belt when assisting him? It gives you different ways of helping him up. You both might benefit greatly from a home care safety assessment with some training. Couched in terms of "I need training on how to you safely at home," of course.
I applud you as you handle this situation so well!
Sue

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@sueinmn

The short answer is that CKD can affect both heart rate and blood pressure. So can Atenolol, and the combination of the two might have an additive effect. A call to the doctor would be in order.
Sue

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Sue, as of mid November he will have been on Cholesterol medication (he had shot up from normal to 209) for a year. I'm guessing the doctor will want to check it so either his office will call or I'll call and set him up (he finally said that would be ok as he is hoping the doctor will take him off medications! He dreams a lot.) Tuesday Mayo is deciding if I get a Cochlear Implant so I need to see when it will be so I can get Bill scheduled. He is no longer up to driving.

I was wondering if the Atenolol needed to be adjusted or stopped. He has been taking it since about 1990 and kept his BP at a perfect range as well as his pulse.

Now trying to figure out a way to get him off the toilet seat - the safety railings are no longer enough and he weighs close to 100 pounds over me since he lost weight - he is almost a head taller as well!

Thank you for your help and suggestion. Julie

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@billchitwood

His pulse (and blood pressure) were always in a good range with his med. A few months ago BP and pulse started dropping with pulse into the 60's. Then a few weeks ago his pulse has dropped into the 50's. Not sure if it is related to his CKD or not. GRF at 47 a month ago (he paid for his own kidney blood test). Still resisting doctor. Today he is getting his flu shot and possibly Covid-19 Pfizer booster shot at local CVS.

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The short answer is that CKD can affect both heart rate and blood pressure. So can Atenolol, and the combination of the two might have an additive effect. A call to the doctor would be in order.
Sue

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@amandaa

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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His pulse (and blood pressure) were always in a good range with his med. A few months ago BP and pulse started dropping with pulse into the 60's. Then a few weeks ago his pulse has dropped into the 50's. Not sure if it is related to his CKD or not. GRF at 47 a month ago (he paid for his own kidney blood test). Still resisting doctor. Today he is getting his flu shot and possibly Covid-19 Pfizer booster shot at local CVS.

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@gingerw

@billchitwood Were these test results also forwarded to his doctor? That would be a good first step to understanding where your husband's condition is right now, as the dr will look at trends in the test results, not relying strictly on one set. Are you able to make sure he/she gets them?

Perhaps your husband will be more willing to have a doctor visit if their office calls to discuss the results!
Ginger

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Since he is still showing in Stage 3 a he is a happy camper. He is reluctant to send them to his doctor as he thinks he doctor could be upset that Bill had his own test done. Since the doctor is (or at least was) following his cholesterol - last test done last November, I'm guessing they might be calling him in for a follow-up. Or at least his KY doctor was always having staff call him in to follow up on things. At which point I wouldn't have a problem getting him in. Maybe!

Still having the low diastolic readings almost daily. Pulse low as well - in 50s.

Thanks for help. Julie

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@billchitwood

Bill wouldn't go to his doctor but did decided to have a kidney prolife done at the Sonora Quest lab nearby. Previously his GRF was jumping around from 42 - 55 (55 was previous reading). In yesterdays test the GFR shows 48. Didn't know if these results were good news or not - does it mean he has Albumin in his urine? Many thanks for help in understanding the results.
Kidney Profile*
Creatinine 1.32 0.60 - 1.50 mg/dL
GFR Estimated (Non-African
American)
48 L ≥60 mL/min/1.73m2
GFR Estimated (African American) 55 L ≥60 mL/min/1.73m2
Creatinine, Urine, Random 225 19 - 280 mg/dL
Urine Albumin, Random 25 Not Established mg/L
Urine Albumin/Urine Creatinine Ratio 11 ≤29 mg/g creat
*Kidney Profile: Albuminuria Categories in Chronic Kidney Disease
Urine Albumin/Urine Creatinine Ratio (mg/g Creatinine):
Normal/Mild Increase: <30 mg/g Creatinine
Moderately Increased: 30-300 mg/g Creatinine
Severely Increased: >300 mg/g Creatinine
Urine albumin and creatinine have high biological variation and may be affected by other
pathological and/or physiological events, to include age, sex, race, exercise, upright posture,
UTI, and septicemia. Patients with values between 30 and 300 mg/g should undergo
additional tests within 2 months to confirm albuminuria. Collect these additional samples 1-2
weeks apart, ideally as a first morning specimen. The elevation of 2 out of 3 of these
specimens is indicative of prolonged albuminuria.
Kidney Inter Supp. 2013;3:1-15

Jump to this post

@billchitwood Were these test results also forwarded to his doctor? That would be a good first step to understanding where your husband's condition is right now, as the dr will look at trends in the test results, not relying strictly on one set. Are you able to make sure he/she gets them?

Perhaps your husband will be more willing to have a doctor visit if their office calls to discuss the results!
Ginger

REPLY

Bill wouldn't go to his doctor but did decided to have a kidney prolife done at the Sonora Quest lab nearby. Previously his GRF was jumping around from 42 - 55 (55 was previous reading). In yesterdays test the GFR shows 48. Didn't know if these results were good news or not - does it mean he has Albumin in his urine? Many thanks for help in understanding the results.
Kidney Profile*
Creatinine 1.32 0.60 - 1.50 mg/dL
GFR Estimated (Non-African
American)
48 L ≥60 mL/min/1.73m2
GFR Estimated (African American) 55 L ≥60 mL/min/1.73m2
Creatinine, Urine, Random 225 19 - 280 mg/dL
Urine Albumin, Random 25 Not Established mg/L
Urine Albumin/Urine Creatinine Ratio 11 ≤29 mg/g creat
*Kidney Profile: Albuminuria Categories in Chronic Kidney Disease
Urine Albumin/Urine Creatinine Ratio (mg/g Creatinine):
Normal/Mild Increase: <30 mg/g Creatinine
Moderately Increased: 30-300 mg/g Creatinine
Severely Increased: >300 mg/g Creatinine
Urine albumin and creatinine have high biological variation and may be affected by other
pathological and/or physiological events, to include age, sex, race, exercise, upright posture,
UTI, and septicemia. Patients with values between 30 and 300 mg/g should undergo
additional tests within 2 months to confirm albuminuria. Collect these additional samples 1-2
weeks apart, ideally as a first morning specimen. The elevation of 2 out of 3 of these
specimens is indicative of prolonged albuminuria.
Kidney Inter Supp. 2013;3:1-15

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@czsalt64

I feel you. My mom wanted to die at home and people get purple blotches on them before they die. Not saying he is dying, but I helped my mom and it's a scary hard road, but I believe that people should have their wishes respected. I am not going to lie though...it was a really stressful situation made 1,000 Xs stressful by family members who were not much invovled but wanted to give their two cents. And at some point for all of us, it is just pain management. And if I could do it all over again...help mom die at home, I would. And I would find ways to do it even better. So enjoy your jorney as silly as that sounds to say. I just remember my mom telling me "This dying thing is easy." And that lightened my heart to know that.

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What you did for your Mom was wonderful. Our daughter did that for her husband with the help of hospice. Bill is happy. Which is the best thing. And fortunately he can get to his walker, watch TV and play with his computer (when he isn't fighting with it).

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