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Blood pressure management in children on dialysis

F Paglialonga1, S Consolo2, A Edefonti2

  • 1Pediatric Nephrology, Dialysis and Transplant Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 9, 20122, Milan, Italy. fabio.paglialonga@policlinico.mi.it.

Pediatric Nephrology (Berlin, Germany)
|June 11, 2017
PubMed

Insights

Managing hypertension in children on dialysis requires careful blood pressure monitoring and volume control. Strategies include identifying dry weight, reducing interdialytic weight gain, and optimizing dialysis methods for better cardiovascular outcomes.

Area of Science:

  • Pediatric Nephrology
  • Cardiovascular Research
  • Hypertension Management

Background:

  • Hypertension is a significant complication in children undergoing dialysis, contributing to cardiovascular issues.
  • Volume overload and renin-angiotensin-aldosterone system activation are key pathophysiological factors.
  • Current blood pressure control in pediatric dialysis patients remains suboptimal.

Purpose of the Study:

  • To review current strategies for managing hypertension in children on dialysis.
  • To highlight the importance of volume management and its impact on blood pressure control.
  • To identify areas for improvement in antihypertensive therapy and long-term outcomes.

Main Methods:

  • Assessment of ambulatory blood pressure monitoring (ABPM) as a primary diagnostic tool.
  • Emphasis on accurate dry weight determination using bioimpedance analysis and blood volume monitoring (BVM).
  • Evaluation of strategies to reduce interdialytic weight gain (IDWG), including dietary modifications and optimized dialysis techniques.

Main Results:

  • Higher IDWG is linked to increased left ventricular mass index and poorer blood pressure control.
  • Optimized peritoneal dialysis and intensified hemodialysis/hemodiafiltration improve fluid and sodium management, leading to better BP.
  • Lack of comparative studies on antihypertensive agents in pediatric dialysis patients.

Conclusions:

  • Effective hypertension management in children on dialysis necessitates meticulous volume control and accurate BP assessment.
  • Reducing IDWG through lifestyle and dialysis optimization is crucial for improving cardiovascular health.
  • Further research is needed to guide antihypertensive drug selection and enhance long-term patient outcomes.

Keywords:
Blood pressureBlood volume monitoringChildrenDialysisEnd-stage renal diseaseSodium overloadVolume overload

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