As a hemodialysis nurse, I know how confusing ESRD can be to someone new to it. It is possible this person has been a non-compliant renal/cardiac/diabetic patient for a while and as a result, the strain of consistent excess fluid volume on the heart has caused permanent damage, thereby the heart muscle is weakened and is unable to pump effectively. My question is this: with a blood pressure chronically this low, how does the dialysis graft stay open (not clotted) and how are they able to dialyze this patient at all.?