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Blood pressure target for the dialysis patient

Wendy McCallum1, Mark J Sarnak1

  • 1Department of Medicine, Division of Nephrology, Tufts Medical Center, Boston, Massachusetts.

Seminars in Dialysis
|November 14, 2018
PubMed

Insights

Blood pressure targets for dialysis patients are unclear. While low blood pressure (BP) may seem beneficial, it

Area of Science:

  • Nephrology
  • Hypertension Management
  • Clinical Research

Background:

  • The optimal blood pressure (BP) target for patients undergoing dialysis is a subject of ongoing debate.
  • Advances in BP management for the general population cannot be directly applied to dialysis patients.
  • Observational studies in dialysis populations suggest a link between low BP and adverse outcomes, potentially due to confounding factors.

Purpose of the Study:

  • To review the current understanding of blood pressure targets in dialysis patients.
  • To evaluate the prognostic value of different BP measurement methods in this population.

Main Methods:

  • Review of observational studies and clinical trial data concerning BP in dialysis patients.
  • Comparison of prognostic information from in-center predialysis BP measurements versus home BP monitoring and ambulatory blood pressure monitoring (ABPM).

Main Results:

  • A linear relationship between BP and mortality is observed in dialysis patients with fewer cardiovascular comorbidities and longer survival.
  • Home BP measurements and ABPM provide greater prognostic insight compared to in-center predialysis readings.
  • Existing data suggest low BP may be associated with worse outcomes, but this is likely confounded.

Conclusions:

  • Current evidence is insufficient to establish definitive BP targets for dialysis patients.
  • Further large-scale clinical trials are necessary to guide recommendations for BP management in this cohort.

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