DEAR DR. GOTT: I am a female with ESRD, stage 4. My doctor prescribed 100 mg metoprolol approximately 2 ½ years ago. Before that he had prescribed another high blood pressure medicine. My problem is that I am slowly gaining weight, over 20 pounds in two years, and lately I have frequent diarrhea. I am also tired most of the time. I am an older woman and realize that my metabolism is slower and may be contributing to my weight gain. However, I try to stay away from fried foods and processed foods. I exercise about three to four times a week for 30 minutes. Could the metoprolol be causing weight gain and is there a better blood pressure medicine that my doctor could prescribe? Thank you.
DEAR READER: For other readers who may be unaware, ESRD stands for end-stage renal disease, a condition that signifies the almost complete failure of the kidneys to work efficiently. It is likely your kidneys may have begun slowing down 10 or even 20 years before you entered this stage. The most common causes for this to occur are high blood pressure and diabetes.
There are many symptoms of ESRD, to include fatigue, bone pain, tingling of the extremities, insomnia, loss of appetite, excessive thirst and weight loss (not gain). So, we cannot blame your weight gain on your kidney failure.
Side effects of metoprolol can include diarrhea, fatigue, flu-like symptoms, headaches and sudden weight gain. And, here it seems, you may have your answer. You don’t mention any other medications so I cannot determine (should you be taking any) if they may be to blame. I recommend you speak with your nephrologist about this issue to determine if another medication, perhaps in a different class, can be substituted for the metoprolol. You certainly have enough problems on your plate as it is without adding 20 pounds to the load.
Treatment for ESRD consists of two possibilities – dialysis or kidney transplant. For the purposes of this discussion, I will discuss hemodialysis, a process whereby blood from the body is filtered, harmful substances are removed, and the “purified” blood is then pumped back into the body again. This routine takes about three hours and is performed about three times each week. There are dialysis centers in many hospitals today although, a nightly home program is another possible option. The advantage to this is that the waste products are removed every evening which is easier for the heart as well as for the access site. And, blood pressures appear to be reduced to the degree medication is no longer required. This process involves training by a dialysis nurse to teach a patient and care givers how to handle equipment, insert a needle into the access site and more. There are risks of dialysis; however, it is literally lifesaving.
Kidney transplant is very common in our country. A donor may even provide a kidney through a laparoscopic technique that simply requires small surgical cuts into the skin, allowing for faster recovery. If you were to undergo transplant, the surgeon will place the new healthy kidney inside the lower abdominal area. The damaged kidneys will ordinarily be left in place unless they are causing hypertension, infection, or other problems. The entire procedure takes about three to four hours. As with any surgery, there are risks. In this instance, they can include bleeding, infection, heart attack or stroke, and blood clots. You will be on medication for the rest of your life once the procedure is completed – a small price to pay for beating ESRD.
Readers who would like related information can order my Health Reports “Kidney Disorders” and “Hypertension” by sending a self-addressed, stamped number 10 envelope and $2 US or money orders (for each report ordered) to my attention at PO Box 433, Lakeville, CT 06039. Be sure to mention the title(s) when writing or print out an order from my website www.AskDrGottMD.com.
