Timing of blood pressure medications and intradialytic hypotension

Wang, Katherine M.; Sirich, Tammy L.; Chang, Tara I.

doi:10.1111/sdi.12777

Cited by 9 publications

(3 citation statements)

References 44 publications

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“…It’s crucial to be cautious with antihypertensive medications, as some might exacerbate the risk of IDH. As many as 50–90% of ESKD patients suffer from hypertension [ 167 ], and finding the balance between antihypertensive management and IDH risk can be a significant challenge due to fluid removal during dialysis [ 25 ]. Excessive fluid volume is a common cause of high blood pressure in dialysis patients, and the use of antihypertensive drugs needs careful management to avoid exacerbating IDH.…”

Section: Intra- and Extra-dialytic Proceduresmentioning

confidence: 99%

Hemodialysis Procedures for Stable Incident and Prevalent Patients Optimize Hemodynamic Stability, Dialysis Dose, Electrolytes, and Fluid Balance

Stuard,

Ridel,

Cioffi

et al. 2024

JCM

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The demographic profile of patients transitioning from chronic kidney disease to kidney replacement therapy is changing, with a higher prevalence of aging patients with multiple comorbidities such as diabetes mellitus and heart failure. Cardiovascular disease remains the leading cause of mortality in this population, exacerbated by the cardiovascular stress imposed by the HD procedure. The first year after transitioning to hemodialysis is associated with increased risks of hospitalization and mortality, particularly within the first 90–120 days, with greater vulnerability observed among the elderly. Based on data from clinics in Fresenius Medical Care Europe, Middle East, and Africa NephroCare, this review aims to optimize hemodialysis procedures to reduce mortality risk in stable incident and prevalent patients. It addresses critical aspects such as treatment duration, frequency, choice of dialysis membrane, dialysate composition, blood and dialysate flow rates, electrolyte composition, temperature control, target weight management, dialysis adequacy, and additional protocols, with a focus on mitigating prevalent intradialytic complications, particularly intradialytic hypotension prevention.

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Section: Intra- and Extra-dialytic Proceduresmentioning

confidence: 99%

Hemodialysis Procedures for Stable Incident and Prevalent Patients Optimize Hemodynamic Stability, Dialysis Dose, Electrolytes, and Fluid Balance

Stuard,

Ridel,

Cioffi

et al. 2024

JCM

View full text Add to dashboard Cite

show abstract

“…Itʹs crucial to be cautious with antihypertensive medications, as some might exacerbate the risk of IDH. As many as 50-90% of ESKD patients suffer from hypertension [164], and finding the balance between antihypertensive management and intradialytic hypotension (IDH) risk can be a significant challenge due to fluid removal during dialysis [13]. Excessive fluid volume is a common cause of high blood pressure in dialysis patients, and the use of antihypertensive drugs needs careful management to avoid exacerbating IDH.…”

Section: Antihypertensive Drugsmentioning

confidence: 99%

Hemodialysis Procedures for Stable Incident and Prevalent Patients to Optimize Hemodynamic Stability, Dialysis Dose, Electrolytes, and Fluid Balance

Stuard,

Ridel,

Cioffi

et al. 2024

Preprint

View full text Add to dashboard Cite

The demographic profile of patients transitioning from chronic kidney disease to renal replacement therapy is changing, with a higher prevalence of aging patients with multiple comorbidities such as diabetes mellitus and heart failure. Cardiovascular disease remains the leading cause of mortality in this population, exacerbated by the cardiovascular stress imposed by the HD procedure. The first year after transitioning to hemodialysis is associated with increased risks of hospitalization and mortality, particularly within the first 90–120 days, with greater vulnerability observed among the elderly. This review, based on data from clinics of Fresenius Medical Care Europe, Middle East, and Africa NephroCare, aims to optimize hemodialysis procedures to reduce mortality risk in stable incident and prevalent patients. It addresses critical aspects such as treatment duration, frequency, choice of dialysis membrane, dialysate composition, blood and dialysate flow rates, electrolyte composition, temperature control, target weight management, dialysis adequacy, and additional protocols, with a focus on mitigating prevalent intradialytic complications, particularly intradialytic hypotension prevention.

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“…Nighttime dosing of these medications is being suggested to minimize the risk. 58 At the same time, use of antihypertensive drugs with negative chronotropic effects and alpha blockers are described to exacerbate IDH by impairing the compensatory responses. 59 , 60 These effects are more significant in the setting of acidosis due to suppressed cardiac contractility.…”

Section: Risk Factors Of Intra Hemodialysis Hypotensionmentioning

confidence: 99%

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

Hamrahian,

Vilayet,

Herberth

et al. 2023

IJNRD

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Intradialytic hypotension, defined as rapid decrease in systolic blood pressure of greater than or equal to 20 mmHg or in mean arterial pressure of greater than or equal to 10 mmHg that results in end-organ ischemia and requires countermeasures such as ultrafiltration reduction or saline infusion to increase blood pressure to improve patient's symptoms, is a known complication of hemodialysis and is associated with several potential adverse outcomes. Its pathogenesis is complex and involves both patient-related factors such as age and comorbidities, as well as factors related to the dialysis prescription itself. Key factors include the need for volume removal during hemodialysis and a suboptimal vascular response which compromises the ability to compensate for acute intravascular volume loss. Inadequate vascular refill, incorrect assessment or unaccounted changes of target weight, acute illnesses and medication interference are further potential contributors. Intradialytic hypotension can lead to compromised tissue perfusion and endorgan damage, both acutely and over time, resulting in repetitive injuries. To address these problems, a careful assessment of subjective symptoms, minimizing interdialytic weight gains, individualizing dialysis prescription and adjusting the dialysis procedure based on patients' risk factors can mitigate negative outcomes.

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Timing of blood pressure medications and intradialytic hypotension

Cited by 9 publications

References 44 publications

Hemodialysis Procedures for Stable Incident and Prevalent Patients Optimize Hemodynamic Stability, Dialysis Dose, Electrolytes, and Fluid Balance

Hemodialysis Procedures for Stable Incident and Prevalent Patients Optimize Hemodynamic Stability, Dialysis Dose, Electrolytes, and Fluid Balance

Hemodialysis Procedures for Stable Incident and Prevalent Patients to Optimize Hemodynamic Stability, Dialysis Dose, Electrolytes, and Fluid Balance

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects

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