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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@billchitwood

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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If you call the dr office, ask the nurse or staff if that is acceptable, so the dr will have some background information before he sees his patient. It is my thought he would like to see that, but that's just me talking! How your husband presents the day of the appt may not be a clear picture without your notes.
Ginger

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@sueinmn

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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He has no strength except in his hands (grabs me a lot lol). He is 88 and I'm 81. I did get him set up with a walker and he actually used it the other day when we went to get our Covid-19 Booster and flu shot. He hardly made it home and we are only about a mile away from CVS. At least he could sit on it while waiting the short amount of time. We've tried all the different heights on the bars. I started looking into a riser seat (left a message with doctor's office regarding it but haven't heard back yet. Everything seems to go to voice mail and gets lost in cyber space. I'm not sure I would be up to using a transfer belt. Daughter Robin is fairly close and I'm supposed to call her immediately if I need help and neighbors have offered as well. Of course Robin is 62 but you would never guess it! Grandkids are about an hour drive away. He just never wants me to call for help. Hasn't been able to get out of a tub since 2014 - well I had to get him out and boy was that a production! We do have a bench and handheld shower head which he has consented to use part of the time.

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@billchitwood

He has no strength except in his hands (grabs me a lot lol). He is 88 and I'm 81. I did get him set up with a walker and he actually used it the other day when we went to get our Covid-19 Booster and flu shot. He hardly made it home and we are only about a mile away from CVS. At least he could sit on it while waiting the short amount of time. We've tried all the different heights on the bars. I started looking into a riser seat (left a message with doctor's office regarding it but haven't heard back yet. Everything seems to go to voice mail and gets lost in cyber space. I'm not sure I would be up to using a transfer belt. Daughter Robin is fairly close and I'm supposed to call her immediately if I need help and neighbors have offered as well. Of course Robin is 62 but you would never guess it! Grandkids are about an hour drive away. He just never wants me to call for help. Hasn't been able to get out of a tub since 2014 - well I had to get him out and boy was that a production! We do have a bench and handheld shower head which he has consented to use part of the time.

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Given your ages and the weight difference, you don't sound like a candidate for a transfer belt to me now that I think aboutit. But maybe look into the riser. No doctor's note or prescription needed.
And some home safety evaluation help is definitely in order before the two of you have a crisis that lands one of you in the hospital. I do not say this casually, I have seen it happen too much!
Ginger's suggestion to make some notes is a great one.
Sue

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@sueinmn

Given your ages and the weight difference, you don't sound like a candidate for a transfer belt to me now that I think aboutit. But maybe look into the riser. No doctor's note or prescription needed.
And some home safety evaluation help is definitely in order before the two of you have a crisis that lands one of you in the hospital. I do not say this casually, I have seen it happen too much!
Ginger's suggestion to make some notes is a great one.
Sue

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I'm guessing Medicare won't pay for any of those. I've got both a Lowe's and Home Depot near by. Lowe's always gives a military discount as Bill served in the Navy during the Korean War (doesn't qualify for any Vet help.

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He thinks he should take over the counter sleeping pills (and whatever is advertised on TV). I don't think it is a good idea and keep telling him he has to ask his doctor. He will agree and then an hour later he will tell me about another wonder pill he has found or a 'doctor' or 'celeb' on TV swears by! They just need his credit card.

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Probably needs to come off some meds. But probably should see a Dr.

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@czsalt64

Probably needs to come off some meds. But probably should see a Dr.

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You need help too. Are there home health care workers in your area?

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@billchitwood

He thinks he should take over the counter sleeping pills (and whatever is advertised on TV). I don't think it is a good idea and keep telling him he has to ask his doctor. He will agree and then an hour later he will tell me about another wonder pill he has found or a 'doctor' or 'celeb' on TV swears by! They just need his credit card.

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Keep a tight grip on those credit cards! In addition to delivering medications or supplements he shouldn't have, once you give them the credit card number, you have signed up for an endless subscription to them that is very hard to stop. Depending on how his memory is, you could write down the name and agree to "get it at the store next time" - then forget.

If you can, get his doctor to declare his kidney disease as End Stage Renal Failure - helps qualify for additional benefits. Your diary may help. Please also record any times he is unable to get up without substantial help, and EVERY fall.

I will be honest Julie, as his condition declines, I am very concerned for your health and safety. Think about what would happen if you both fell, trying to get him up from the toilet? Think how badly you would be hurt if he fell on top of you, and what a crisis it would cause for both of you. I am not trying to be alarmist - this has happened to loved ones too often in my lifetime. Would you be willing to message the doctor that you want a referral to someone to do a home safety assessment & ask him to bring up the subject?

I will be keeping you in my thoughts!
Sue

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@sueinmn

Keep a tight grip on those credit cards! In addition to delivering medications or supplements he shouldn't have, once you give them the credit card number, you have signed up for an endless subscription to them that is very hard to stop. Depending on how his memory is, you could write down the name and agree to "get it at the store next time" - then forget.

If you can, get his doctor to declare his kidney disease as End Stage Renal Failure - helps qualify for additional benefits. Your diary may help. Please also record any times he is unable to get up without substantial help, and EVERY fall.

I will be honest Julie, as his condition declines, I am very concerned for your health and safety. Think about what would happen if you both fell, trying to get him up from the toilet? Think how badly you would be hurt if he fell on top of you, and what a crisis it would cause for both of you. I am not trying to be alarmist - this has happened to loved ones too often in my lifetime. Would you be willing to message the doctor that you want a referral to someone to do a home safety assessment & ask him to bring up the subject?

I will be keeping you in my thoughts!
Sue

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Those are very good ideas! For some years now we have gone through this with online hearing aids (free trial that I have to move mountains to get our money back). I took him and got him a prescription good hearing aid set (just took him in for an adjustment) and he is still wanting to buy what he sees on TV! Same with glasses. I do have his credit cards. And I do use the trick of telling him I'll order it or pick it up lol. Boy, can I be forgetful!

This morning he commented on what I have been noticing - that he is getting paler. Daughter noticed as well. Since we are going to be in lovely 90s today with some clouds I suggested he get a little sun (which he loves to do).

A month ago I got him in for an out of pocket (he wouldn't contact the doctor) blood test for his CKD and his GFR was at 47 - still stage 3a (bounces between a and b) - So I'm not sure the doctor could qualify him at end stage.

I do know last few weeks he has seemed worse. I took a video of him getting back from the bathroom the other day. When he does see the doctor he puts on a good act! Smartphones are handy little things.

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He finally conceded and daughter and I hauled him off to the doctor this morning. The ran all sorts of blood tests and Dr is going to recommend he be evaluated for Medicare home health or palliative care/hospice. We are dwelling on the home health angle as he is comfortable with that. Dr N also have him some samples of Creon for his chronic diarrhea (he was glad I had kept records of what was happening). I'm guessing the agency won't call until they get the blood test results back.

Dr N also said to let him eat whatever he wants and how little or much. So Robin bought him a large ice cream cone on the way home. Lunch!

Thank you for all of the suggestions. Oh, Dr N said he can not take any of the otc and/or TV/Internet ads without checking with him first! Since Bill really respects Dr N (sort of the old family doctor we grew up with that knew you well and was always there) he promised to follow his instructions.

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