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6 eGFR Equations (beta)


Can anyone tell me what 'Normal' ranges are for blood pressure?


© 1997 Andrew Lundin, M.D. All rights reserved. Reproduced with permission.

It depends mostly on age. Children and adolescents should always be fairly low. I am not sure of the ranges. For adults the most often recommended upper limit is less than 130/90 mmHg. However, anyone who has BP levels lower than this and feels perfectly functional is in a good position. Those who have higher blood pressures and feel nonfunctional when the BP comes below this number, in most instances are storing extra but invisible fluid amounting to several lbs. In older patients one must be careful not to bring the BP down too fast. If arteries are narrowed then a stroke or heart attack could occur. Nevertheless, when done with appropriate caution, in my experience, almost everyone can be made normotensive on dialysis.

For those that have had a problem with low bp how do you correct the problem?

Blood pressure is controlled by an interaction between the heart and peripheral arterioles (small arteries) that are in line just before the capillaries (small tufts of vessels that connect the arteries and veins, in the kidney they are called glomeruli). Think of the vascular system as two adjoining trees connected only at the smallest branches. A fistula or graft would be making a connection between two of the larger branches.


To get to the point, high blood pressure is due to an increase in the cardiac output of blood or increased constriction of the arterioles or variable combinations of both. It is thought that the increased cardiac output comes first stimulating a constricting response in the arterioles that eventually dominates the picture. Most antihypertensive medications today are directed at dilating the arterioles. It is not clear whether the hypertensive effect of EPO in some patients is due to increase blood volume (increased cardiac output) or release of substances that constrict the arterioles.


Causes of hypotension must therefore be due to decreases in cardiac output or dilatation of the arterioles. A diseased heart could cause the former but that is unusual. More likely, if the heart is involved, the low BP is due to volume depletion (being below dry weight). This is seen in patients who have good appetites and are eating well. Blood pressure medications often work better when the patient is dry. It can be a vicious cycle. Some medications like Ca channel blocks and ACE inhibitors can cause fluid retention, which negates their antihypertensive benefits. In non-ESRD hypertensive patients diuretics are often required. For dialysis patients getting to dry weight offers the ability to stop BP meds.

Pete Lundin, M.D.

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