So confused...

[bluesette]

Hi! I posted a few months ago as a newbie. Since then have been to see a nephrologist twice and have another appt in July. He's a very respected doctor in this area. My last egfr was 42. I'm 75 yrs old. Creatinine was 1.29, BUN was 19. Dr told me on first visit my blood pressure was too low and kidneys don't like low blood pressure. It was134/82 taken in his office but I told him it measures lower at home and showed him my BP log where BP averaged 109/68 for Nov 2020. So since then, he has lowered my bp med in half and then again into quarters. I'm now taking 5 mg of olmesartan. BP has come up to average of 114/76 for March. He said the Diastolic was too low in the 70's and Systolic should be in 130's for my age. He said I don't need to watch amount of salt in food I buy, just don't add any additional salt. I have watched salt for many years and this was a shock to me. What do you think if this? I really need to know!

[Hidden]

I'm surprised that he is telling you that your diastolic BP in the 70's is too low. Mine is consistently in the 70's and it is not an issue. I still have to eat low sodium foods and never add salt to anything. Do you have any other issues with your heart that he wants the readings to be higher? Your systolic home reading numbers are low for most people but what surprises me about his advice is this. If the manufacturer of the pill scores the pill then the effectiveness of the pill when cut doesn't diminish. However, if you cut a pill that isn't scored (and then cut it again) it may very well lose some of its effectiveness. I have one pill that is scored and several years ago my physician had me reduce the dosage to half and the scored pill was easy to do and the result was that I had no drop in effectiveness. A couple of my doctors have asked me to cut other pills that are unscored and when I questioned them they said there was no diminished effectiveness by cutting them.

I contacted the pills manufacturer and they told me that if the pill isn't pre-scored then cutting it was not recommended. When I contacted my physicians and explained this, one changed the frequency. Instead of one pill every week, one doctor had me take one pill every two weeks, and the other physician let the current dosage go. As a result, over the last 14 months, my labs for the issue the pill was being taken for have all been well within the reference range.

I learned to check things out and ask questions about why they are increasing or decreasing medication dosages by cutting any unscored pill. Some doctors suggest this to try and save a patient money on prescriptions, but if the medication is less effective, are you really saving anything?

[bluesette in reply to Hidden]

I am sorry. I forgot to tell you that I am now on a whole pill of 5 mg of olmesartan taken every other day. It is my thyroid med that I have to cut in half Levothyroxine 25 MCG. I take Gabapentin for osteoarthritis 400 MG 3 times a day. No heart issues ever. I told my kidney dr the last thing my family doctor said when I left my appt was watch the salt. He said no.

[nellie237 in reply to bluesette]

Hi Bluesette,

I would recommend that you listen to your nephrologist.

I think that there is a broad understanding that the majority of us consume too much salt which increases blood pressure, and family doctors tend to run on auto-pilot.......so, it is just a reflex for them to tell everybody to cut down on salt.

Your nephrologist on the other hand has clearly considered your blood work, and I am sure has a valid reason for his unexpected/unusual comments. It may be that as well as your blood pressure, your sodium levels may also be a bit low. Increasing your blood pressure a bit should improve your eGFR ie Instead of the fluid going through the filter at a trickle it will have a bit more pressure behind it. I have the opposite problem with high blood pressure. Kidneys don't like low or high blood pressure.

Its going to be quite difficult to stop restricting salt in your diet - I imagine it will taste horrid.🥴 I've only been restricting salt for a short time, and I'm already finding that some basic foods like bread can now have too much salt for my liking. Any increase/decrease in sodium should be done slowly.

For your own peace of mind, I suggest that you ask for copies of your blood results.....then when you go for your appointment in July you can ask questions and make notes.

Edit: I am also hypothyroid - I expect you know that cutting Levo in half is fine.

[bluesette in reply to nellie237]

Thank you for your reply! It has put me more at ease.

[Jayhawker in reply to nellie237]

I had to increase my sodium intake several years ago because my BP was too low. Good did taste terrible!

Jayhawker

[Marvin8]

I've never heard of 109/68 or diastolic in the 70's as being hypo intensive. Sounds weird to me. I'm 63 and would LOVE to have 109/68 bp. The only negative would be if you get dizzy too easily upon standing or normal exertion.

[CatOnACloud]

Sorry, I’d have a hard time following this drs advice considering his information on blood pressure is erroneous. Facts are facts—know them well—then search for a physician that can help, not confuse you further.

[orangecity41 NKF Ambassador]

I am 79 (soon to be 80) and my BP is around 105/70 most time and has been as low as 102/57. No mention about any issues. I do not take any BP meds. I am at CKD 3b. My BUN is at 18. I wonder if age might be a factor also?

[Hidden in reply to orangecity41]

Age can be a factor and what I've been told is that if my energy level drops, my BP may drop and unless other issues flare up it's okay. Signs would be dizziness, fatigue, dehydration, and even a loss of appetite. So, BP readings can get lower as we age and without additional symptoms it's usually not a call for worry. My cardiologist has me recording my twice a day readings and I bring them to him at each appointment. If from one month to the next my average drops by 5 - 10% I fax him the sheet and he'll get back to me with any recommendations/changes.

[orangecity41 NKF Ambassador in reply to Hidden]

Thanks for good information.

[Darlenia]

Hi Bluesette. We're all unique human beings. On the surface, your blood pressure seems okay to me. But, of course, we don't know your complete health history nor are we able to diagnose your situation. I would, however, simply like to point out that sodium is an electrolyte and works hand-in-hand with chloride, potassium, phosphorus, magnesium and more to make your body work optimally. And, in this mix, you're throwing in thyroid issues which influence metabolism, kidney conditions which influence water levels, as well as increased age and so forth. I'm a healthy 70 year who removed sodium from her diet to be supportive to my hubby, now on dialysis. My blood pressure plummeted (90s/50s), my heart went into an erratic pounding rhythm, etc. I was nearly hospitalized. Because of this low sodium/chloride issue, I also fainted three times in succession in a restaurant. Today, it hovers in the low normal range even though I vigorously shake the salt shaker. Obviously, salt is a necessary life mineral, not the evil item people often make it out to be. We all have things going on which requires comprehensive analysis by professionals against the backdrop of age and ailments. I've personally noticed that lab numbers that are okay for young people seemingly make a rather dramatic change as we age - ferritin for women for example - and which lab reports don't address. A1c's can also be affected and more. Thankfully, I'm very comfortable in discussing matters with my physician. It seems to me that your nephrologist has great perspective of your situation and is tweaking/manipulating a key electrolyte to improve your kidney health. But if you're uncertain about his professional capabilities or communications skills, you may want to seek a second opinion. Knowledge is power. Sending encouragement and peace your way.

[Jayhawker in reply to Darlenia]

In addition to what you said, there is a close relationship to sodium as measured in our renal panel data and our hydration levels. My nephrologist can tell when my hydration is off by looking at my sodium levels. (Apparently I’ve been chronically dehydrated for several years at this point. So, he’s laser focused on my hydration at right now.

This stuff gets pretty complicated. It’s so very important to have a good nephrologist as well as primary care physician. And, they need to work closely together.

Jayhawker

[Darlenia in reply to Jayhawker]

Yes, yes, and yes!

[Ritzy_Jewels]

Here is a study that shows the danger of blood pressure decline and kidney function decline in older people. pubmed.ncbi.nlm.nih.gov/261... I read somewhere a while ago that we need a medium blood pressure in order to "push" blood and waste products into the kidneys to be filtered. I wish I could find that article. Since I read that, I make a point of keeping my blood pressure in the range your Dr reccomended. You might want to ask him or her if this is his reasoning. Also, I have read that those with low bp can't sustain dialysis if and when needed. You may need to ask your DR what his rational is.

I hope you get this sorted out. My best to you!

[bluesette in reply to Ritzy_Jewels]

Thanks for your reply. It does make sense to me why low blood pressure is a concern.