Table 3 Patient quotes regarding crashing

Experience

Extreme fatigue

“…really completely exhausted. Not the type of exhausted that you feel like you could really just lay down and recover from…you just feel like you’re done for the rest of the day.”

Nausea and Vomiting

“Cause the pressure - when it drops and you feel that weight, you feel nauseous too at the same time…. You start throwing up immediately. I mean uncontrollably sometimes.”

Lightheadedness and Blacking out

“But that passing out thing, you really can’t see or hear. You think you’re responding but you’re not. And people say, “you ain’t saying nothing”.

“And just the feeling of, like getting close to losing consciousness or completely losing consciousness is just scary.”

“It feels like the world is closing in and my head got extremely light.”

Sweating

“...skin became sweaty and clammy.”

Lasting Symptoms

“…it first started dropping, it started in the dialysis center. When I first got on and everything it would always drop there. Then after a while, it kept dropping even when I wasn’t there.”

Perceived Causes

Incorrect post-dialysis target weight

“So they did what they were supposed to do - take the fluids off and bring me to my dry weight. But my dry weight was too low, I had gained weight.”

Fluid gains

“It may be from gaining too much fluid.”

Treatment time

“…there are times when I have to run normal dialysis during the day, which is the four-hour dialysis. I find that I have more low blood pressure episodes on that type of dialysis than nocturnal.”

Perceived Solutions

Patient-driven

Fluid and dietary adherence

 “...monitor their diet…make sure that they’re not going over their daily recommended salt intake.”

 “…gain less weight before they go in for each session.”

Timing of eating

 “...if you haven’t had a decent enough base of carbohydrates, to see you through dialysis, that’s going to lead to crashing.”

Notifying staff of symptoms to facilitate early intervention

 “…watch for signs of hypotension and telling the tech to stop taking fluid off.”

Change Dialysis Modality

 “I would recommend…switching to nocturnal hemodialysis, because I have less low blood pressure episodes on that.”

Dietary Intervention

 “I had a nurse that…suggested drinking a cup of cold ice water, and that actually helps me recover a lot quicker from the low blood pressure episodes.”

Clinician-driven

Change Timing of Blood Pressure Medication

 “My doctor and I played around with my blood pressure medication, so basically on dialysis nights, I just hold my blood pressure medication….”

Change Fluid Removal Goal

 “…they’ll take less of, they’ll do anything they can, to keep you from crashing.”

Slowing or stopping ultrafiltration

 “…cut back the goal on the machine or just stopped the machine from pulling more fluid depending on the severity of the issue.”

Fluid Administration

 “…resolving the low blood pressure problem..[i]t would either be fluid or it would be the broth.”

Trendelenburg position

 “Your blood pressure could drop…they have to tilt your chair back and try and give you fluid.”