Fluid and blood pressure management in maintenance hemodialysis patients

While the majority of the nephrology community would agree that the ideal way to manage the care of a patient on dialysis is through proper volume control strategies, our guidelines and protocols do not reflect these beliefs. The Kidney Disease Outcomes Quality Initiative (KDOQI) has guidelines for treating hypertension in hemodialysis (HD) patients, but it does not provide specific recommendations for managing polypharmacy and deprescribing anti-hypertensive medications. When patients transition from non-dialysis CKD to chronic HD therapy, the requirement for anti-hypertensive medications may change due to the removal of extracellular fluid by ultrafiltration and other factors. Because most blood pressure medications are vasodilators or impact other components of cardiovascular function, they may prevent the normal physiological response to changes in volume during dialysis, leading to intra- or inter-dialytic hypotension, post dialysis fatigue,[1, 2] and a reduced quality of life for patients.[3] Indeed, hypotensive symptoms may occur in more than 20%-50% of dialysis sessions.[1, 4] These symptoms not only make the treatment ineffective or harmful, but also creates a sense of fear in the patients, which makes them resist proposed increases in ultrafiltration volume to achieve or maintain dry weight. Several studies have shown that patients who experience frequent hypotensive events during dialysis have poorer survival.[5, 6] Ultimately, avoiding or minimizing pharmacologic control of blood pressure may facilitate fluid removal and accurate dry weight achievement, which in turn may prevent the myocardial remodeling that is often seen in dialysis patients.[7, 8] This body of work aims to demonstrate the need for and potential eligibility criteria for a comprehensive antihypertensive medication deprescribing protocol in the maintenance hemodialysis population.

Name thesis:degree_name

Ph.D.

Level thesis:degree_level

Dissertation

Discipline thesis:degree_discipline

Community Health

Grantor

University of Illinois at Urbana-Champaign

Year dc:date

2021

Author dc:creator

• Derk, Gwendolyn

Contributors dc:contributor

• Wilund, Ken
• Pai, Amy
• Andrade, Flavia
• An, Roupeng

• Hemodialysis End-Stage Kidney Disease Chronic Kidney Disease Anti Hypertensive Medications Dry Weight Fluid Overload

Statement dc:rights

• Copyright 2020 Gwendolyn Derk

Language dc:language

en

Handle dc:identifier

http://hdl.handle.net/2142/109503

OAI identifier oai:identifier

oai:www.ideals.illinois.edu:2142/109503