Will Diuretics lower BP for ESRD patients?

[NurseMegan2]

Hi!

New Graduate here. Was wondering if any experienced nurse would be able to answer my question. I understand before giving diuretics it is important to check BP because the patient will excrete large amounts of urine, which can lead to low BP. However, what if the patient has ESKD and no longer urinates(on dialysis)? Also why would they even be receiving this medication? My current understanding would be that if the patient is no longer urinating, the blood pressure would not be reduced after administration. Have you seen a diuretic lower BP in a patient that is no longer urinating?(I get as a general rule its good idea to know the patients vitals) But is checking BP immediately before administration a priority, does a diuretic still have the potential to lower the blood pressure in a patient that does not urinate?

Thank you so much!

[traumaRUs, MSN, APRN]

Exactly right - they don't need diuretics if they don't produce urine...

Stop the med

[pluckyduck, MSN, NP]

We get residents in the ER all the time who order Lasix IV for our ESRD patients in CHF exacerbations. I ask the patient as part of my assessment from the get go, “do you make urine?”

“I haven’t peed since 2002, toots. Are they trying to give me lasix again?” -real answer from a patient. ?

If a patient with ESRD needs diuresis emergently and we can’t treat with meds, they usually end up being dialyzed in the ED where I am.

[lovingtheunloved, ASN, RN]

I frequently see Lasix and Bumex ordered for anuric dialysis patients. Ordered by the nephrologists. They don’t work. They patients never pee. Their fluid volume is never reduced by anything except dialysis, and when I ask why the diuretics are ordered I never get a satisfactory answer. If anyone else has some insight I’m all ears.