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Blood pressure management in hemodialysis: what have we learned?

Peixoto, Aldo Ja,b; Santos, Sergio FFc

Current Opinion in Nephrology and Hypertension: November 2010 - Volume 19 - Issue 6 - p 561–566
doi: 10.1097/MNH.0b013e32833f0d82
Dialysis and transplantation: Edited by Jonathan Himmelfarb and Ray Bloom

Purpose of review To review recent developments in the field of hypertension in hemodialysis patients.

Recent findings Despite the fact that hypertension is the most common complication of end-stage kidney disease, no evidence-based blood pressure (BP) targets exist for hemodialysis patients. There is growing evidence that outcomes are better predicted by out-of-office BP values, such as home or ambulatory BP monitoring. Intradialytic hypertension is associated with increased risk of death or hospitalization, and is probably mediated by volume overload. BP management should focus on volume control: dry weight ‘probing’ is well tolerated and effective in lowering BP, as are other strategies that minimize expansion of the extracellular fluid volume, such as avoidance of hypernatric dialysate. We discuss each of these issues in our review.

Summary Modest advances in the understanding of hypertension have occurred in the past 2 years. Clinical trials that focus on BP targets and treatment choices are essential to guide future practice.

aMedical Service, VA Connecticut Healthcare System, West Haven, USA

bSection of Nephrology, Yale University School of Medicine, New Haven, Connecticut, USA

cDivision of Nephrology, State University of Rio de Janeiro (UERJ), Rio de Janeiro, Rio de Janeiro, Brazil

Correspondence to Aldo J. Peixoto, MD, Medical Service – 111, West Haven VAMC, 950 Campbell Avenue, West Haven, CT 06516, USA Tel: +1 203 932 5711 x5907; fax: +1 203 937 3425; e-mail: aldo.peixoto@yale.edu

© 2010 Lippincott Williams & Wilkins, Inc.