High BP during dialysis

[Learning_as_we_go]

Hello, everyone! Today I’m reaching out on behalf of a friend who hasn’t joined this community yet but would greatly appreciate any advice you can offer.

Her mom has been on dialysis for about 3 months and is having a rough go of it. During treatment her mom’s pressure shoots up dangerously high, to the point where an ambulance is being called to take her to the ER from dialysis at least once a week. Her mom is on BP meds (hydralazine and amlodipine) but they don’t seem to be making a difference.

Things are extra complicated because her mom doesn’t have access to affordable health insurance, so no one is helping her figure out a way to fix the problem—the ER doctors are just lowering her BP at the moment and then discharging her due to lack of insurance, and her assigned doctor at the clinic isn’t doing anything to help (I’ve already encouraged her daughter to request a new doctor). She doesn’t have a PCP she can talk to.

Has anyone else dealt with the problem of high BP during/shortly after dialysis treatment? I’ve talked to her daughter about fluid intake and limiting sodium, but is there anything else you guys can think of that might be causing the spike? Her lab work is good, with the only exception being low albumin and hemoglobin. If anyone has any advice on how to deal with this (such as taking BP meds at certain times during the day, other meds to try, changing dialysate mix, etc.) or other things she should be asking about/looking out for, we would really appreciate hearing it!

[Bassetmommer]

My BP was very high for several months when I went on dialysis. For me, it was the stress of it all. I went through the BP med roulette before I was on dialysis and nothing was helping. I was put on hydralazine at one point by the Neph but when I saw the cardiologist, he say not to take it. That is an old BP med and there are a lot better ones out there. Once on dialysis for a while, I was told this trick and it worked. I take 300 irbesartan. But I take 150 before and then 150 after. The dialysis was stripping the medication out of me. It worked great to the point they are talking about lowering the dosage.

How does anyone survive without insurance. Can she get Medicaid? Is she old enough for Medicare. I believe after a while she will automatically go to Medicare when on dialysis. She needs something. The Social worker at the clinic should be helping with that.

[Learning_as_we_go in reply to Bassetmommer]

This is very helpful information, thank you! I wouldn’t be surprised if stress is playing a major role in all of this. I’ll let her daughter know about splitting the med dosage and talking to the doctor about trying irbesartan.

Unfortunately, her mom’s immigration status prevents her from applying for Medicare, Medicaid, or any insurance plans under the Affordable Care Act. She could purchase private insurance directly through the company, but they can’t afford the very expensive premium. I told her about assistance offered through the American Kidney Fund, which I believe helps dialysis patients regardless of citizenship, so hopefully they’ll find some relief there.

The social worker hasn’t been much help. When they asked him and other staff about applying for assistance to pay for things like transportation to dialysis and medications, the social worker and staff said they couldn’t do anything. They are all aware that the mother doesn’t have insurance due to immigration issues. The way they treat her and her daughter is appalling, so I’m trying to help them find answers and other resources. If you know of other organizations besides the AKF that will help pay for some of these things or provide access to doctors, please let me know!

[Bassetmommer in reply to Learning_as_we_go]

Yes, American Kidney Fund does have a good support program. However, immigration statue is going to be a huge issue with every thing. Can she apply for citizenship? How the heck does she even get dialysis without insurance? I cannot imagine having to pay for it out of pocket. I would also see if anyone at National Kidney Foundation has any answers. Yikes poor lady. Let us know how she makes out.

[Learning_as_we_go in reply to Bassetmommer]

Our state uses Emergency Medicaid funding to pay for chair time, but they don’t cover related expenses like transportation, surgeries, medications, etc.

I’ll look into the National Kidney Foundation as well. I don’t think she has anyone who can sponsor her at the moment, so they have a tough road ahead. I’ll keep you guys posted. Hopefully this information can also help someone else going through the same thing…

[Ziggydoodah]

I found Irbesartan was the only BP medication that worked for me. I think I have been on every BP medication. Hope she gets sorted. Dialysis is bad enough, without all the financial worry too.

[drmind]

Ask Whoever is prescribing those meds to change them to the one recommended by others on this site? I had massive problems with both of these medications as had others I'm sure. Sad that as nation of immigrants we are so opposed now to helping those in desperate need. Wish I could help more. Many prayers and positive thoughts. I hope the NKF can help.

[Darlenia]

Each state has its own funding for this. It's a mixed bag of this and that or nothing at all. Undocumented immigrants do have access to emergency Medicaid so she'll have to use that as much as possible. She's already found her way there. My state also provides community health clinics which, I believe, are free and available to everyone. And many of the undocumented rely on churches and charities to provide funds and health support - for example, in my small town, the churches have banded together and have a health clinic, a clothes closet, etc. As a developed nation, we must do better.

[RhenDutchess123 in reply to Darlenia]

We are a Nation in decline...we have an over burdened Health Care System with fewer and fewer Doctors and Nurses entering the Medical Field every year. Many of our own Citizens can't access quality health care either...We have grown too fast and our infrastructure simply cannot handle the influx of uncontrolled immigration, especially for Dialysis patients, which has always been overwhelmed.. we definetly need more Clinics and Providers, but I don't see it improving any time soon

[Darlenia in reply to RhenDutchess123]

Agree. We are a nation splitting into the have and have-nots. Eventually that leads to unrest and decline. A nation's greatest resource is its people . It's folly not to treat them well.

[1EPXiii]

My BP was extremely high before I started D. No meds helped. I had a bilateral Nephrectomy.. both giant diseased kidneys were removed! That was 7 years ago. My BP was actually LOW! But it stabilized. this August will be 8 years on dialysis..

[Live_Positive]

hello

Many have to go through this. Sometimes, My BP used to go up to 230/120.

Effective BP medication management is needed. Dialysis removes the effect of medication from body.

Wish her smooth dialysis. I would say, just ask doc to manage her BP.

[Jk2023]

Hello :)My mam has bp problems also she was told not to take any medication for BP before diaylsis and to take all medication after. Also has her Dr reviewed all her meds my mam was taking off her bp medication she had been on for a while and switched to a different one that was more suitable.

I hope your friends mam feels better soon

[ZenPDX]

I want to second Bassetmommer . Once you are on dialysis she should qualify for Medicare. Dialysis was specifically written into Medicare as a disability.

Also, my BP has been out of wack since I was diagnosed with CKD with sitting BP of over 180/X and standing consistently under 100/X. We have played with my BP meds for the last year with no significant change. I’ve added, eliminated and change amounts and timing to no avail.

Sometimes, CKD just causes changes that can’t be fixed with medication.

Gary