Managing Hypertension in the Dialysis Patient -- Complicated and Important

[okarol]

From Medscape Nephrology
Managing Hypertension in the Dialysis Patient -- Complicated and Important

George Bakris, MD; Rajiv Agarwal, MD

Authors and Disclosures

Posted: 12/02/2010

VIDEO: http://www.medscape.com/viewarticle/733263

[greg10]

Thank you okarol.  This is a good video that covers the following:
As a dialysis patient, what do you do with interdialytic (IED) or intradialytic (IAD) hypertension (HPE) or hypotension (HPO)?
and should you stop taking blood pressure (BP) medicine before dialysis?

You can have the following scenario:

IED          HPE
         x
IAD          HPO

IED-HPE  usually defined as blood pressure over 125/85 between dialysis.  It is important to have hemodynamic stability between dialysis just because you have higher mortality without the stability.  The first line of treatment is to observe with many BP measurements and try to stay to dry weight.  Secondarily is to treat the BP with beta blockers such as Atenolol or Carvedilol for the hypertension.

IED-HPO is low BP between dialysis, it is less common and not covered.  (This may be due to dialysis related conditions such as sepsis, cardiovascular problems)

IAD-HPE usually defined as over 140/90 as the patient gradually becomes hypertensive (HPE) during dialysis (IAD).  This is usually due to volume overload.  The solution is to gradually reduce dry weight and try to gradually approach new dry weight at 0.2 kg intervals.

IAD-HPO usually defined at BP under 100/65 during dialysis, normally related to rapid ultrafiltration (fluid removal).  Reintroduce saline to patient if the patient is crashing.  Reduce UF to 10 ml per kg weight per hour.  (Gradually approach dry weight at 0.2 kg intervals may also be suggested if this is a new patient to hemodialysis)


Should you stop taking blood pressure (BP) medicine before dialysis?  Generally no, because BP medicines are longer acting than just a few hours which the dialysis will take.  Take care of approaches to dry weight, volume overload, UF and regular BP control through beta blocker and you should not need to stop taking BP medicine prior to dialysis.