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Hypertension During Dialysis

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Dr Om Kumar, Patna    13 January 2018

  1. Almost 8-15% of patients have IDH, which is an opposing trend to systolic BP.
  2. Any increase in BP during dialysis increases mortality risk.
  3. Best BP metric is to determine long-term risk of complications/monitoring: average of intradialytic home BP (ABPM-Gold Standard; high prevalence of non-dipping and NH).
  4. There is a strong association between IDH and ECV overload.
  5. HD: There is opportunity to improve BP (ECV). Post-HD: Typically an ongoing increase in systolic BP (4 mmHg every 10 hours).
  6. Nonpharmacological treatment includes sodium, probing dry weight, adequacy pharmacological treatment with antihypertensive drugs (inhibition of endothelin 1 both specific-avosentan and nonspecific ET 1 inhibition-RAAS inhibition or carvediol). Nonvolume dependent causes of hypertension are EPO and OSA.

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