Blood pressure in hemodialysis: Targets?

Panagiotis I. Georgianos, Rajiv Agarwal

Research output: Contribution to journalReview article

4 Scopus citations

Abstract

Purpose of review In the absence of 'hard' clinical-trial evidence to define optimal blood pressure (BP) targets and validate different BP measurement techniques, management of hypertension in hemodialysis is based on expert opinions. In this review, we provide a comparative evaluation of out-of-dialysis BP monitoring versus dialysis-unit BP recordings in diagnosing hypertension, guiding its management and prognosticating mortality risk. Recent findings Owing to their high variability and poor reproducibility, predialysis and postdialysis BP recordings provide inaccurate reflection of the actual BP load outside of dialysis. Contrary to the reverse association of peridialytic BP with mortality, elevated home and ambulatory BP provides a direct mortality signal. Out-of-dialysis BP monitoring, even when done in the clinic, is a reliable approach to manage hypertension in the dialysis unit. Whenever none of these measures are available, median intradialytic SBP can provide a better estimate of interdialytic BP levels compared with peridialytic BP measurements. Summary Although out-of-dialysis BP monitoring have better diagnostic accuracy and prognostic validity, randomized trials are needed to ascertain BP targets for managing hypertension in hemodialysis patients.

Original languageEnglish (US)
Pages (from-to)523-529
Number of pages7
JournalCurrent Opinion in Nephrology and Hypertension
Volume26
Issue number6
DOIs
StatePublished - Nov 1 2017

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Keywords

  • blood pressure targets
  • hemodialysis
  • hypertension
  • mortality
  • treatment

ASJC Scopus subject areas

  • Internal Medicine
  • Nephrology

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