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Updated: Jul 8, 2026
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Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
Blood pressure on dialysis: an ongoing controversy
Eberhard Ritz1, Jutta Pablick-Deetjen, Martin Zeier
1Department of Internal Medicine, Ruperto Carola University of Heidelberg, Germany.
Summary
Optimal blood pressure for hemodialysis patients is a low normal systolic level, balancing survival benefits against risks like hypotension. Individualized approaches and lifestyle changes are key.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Epidemiology
Background:
- Conflicting epidemiological data create uncertainty regarding optimal blood pressure (BP) levels in maintenance hemodialysis patients.
- Both mean arterial pressure and arterial pulse pressure profile influence hemodynamic stress and patient outcomes.
- Pre-dialysis systolic BP is often elevated (>140 mm Hg) while diastolic BP remains normal in hemodialysis patients, indicating reduced arterial elasticity.
Purpose of the Study:
- To clarify the optimal pre-dialysis blood pressure (BP) for survival in patients undergoing maintenance hemodialysis.
- To address the controversy surrounding BP management in this patient population.
Main Methods:
- Analysis of epidemiological surveys and retrospective data on pre-dialysis systolic and diastolic BP in hemodialysis patients.
- Comparison of BP-survival relationships in the general population and dialysis patients.
- Consideration of factors influencing BP, such as arterial elasticity and ultrafiltration.
Main Results:
- Short-term survival appears optimal with pre-dialysis systolic BP between 130-180 mm Hg, with minimal risk increase at higher values.
- Risk of death significantly increases with pre-dialysis systolic BP below 120 mm Hg.
- A continuous positive relationship between BP and long-term survival is observed, similar to the general population.
Conclusions:
- A pre-dialysis systolic blood pressure in the low normal range is generally optimal for survival in hemodialysis patients.
- Individualized BP management is necessary, considering potential side effects and patient-specific factors.
- Strategies like low salt intake, reduced dialysate sodium, and optimized dialysis session length/frequency can help lower BP safely.
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