Blood Pressure Management in Dialysis

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BP meds prior to dialysis

Nurses often find themselves in the situation of having to decide whether or not to give their patient antihypertensive medications prior to sending them off to dialysis.

DR. WEINER AND DR. BOURNE’S ADVICE:

In general, give:
- Beta blockers and calcium channel blockers to prevent unstable tachycardias
- Diuretics to maximize the amount of fluid that can be removed from the patient
ACE inhibitors will be dialyzed out
Call the nephrologist if in doubt

Intradialytic Hypertension

Patients are losing blood volume during dialysis, so we tend to expect that the BP will fall during. But this isn’t always the case.

Intradialytic hypertensions (an increase in the systolic BP by greater or equal than 10 mmHg or the MAP by greater or equal than 15 mmHg.) occurs in ~5-10% of dialysis patients.

CAUSES

ACE inhibitors are dialyzed out
Patient is very fluid overloaded
Sympathetic nervous system stimulation (ie stress, pain)

Intradialytic Hypotension

A common problem during dialysis

CAUSES

Autonomic dysfunction (hormones aren’t able to maintain vascular tone in the setting of fluid loss)
- Diabetes
- Sepsis
- Neurologic disorders
Malnutrition (unable to keep fluid in vessels)
Liver failure

INTERVENTIONS

Take fluid off more slowly
Avoid large meals during dialysis (reduce pooling of blood to gastric areas)
Add volume back with NS
Albumin
Vasopressors (if requiring 2+ pressors, patient will likely switch to CRRT)
Peritoneal dialysis!

A Plug-In for Peritoneal Dialysis

Peritoneal Dialysis in the United States: Lessons for the Future (Hansson, 2020)

Managing blood pressure for dialysis patient can be complicated. Nephrologists Dr. Daniel Weiner and Dr. Bourne Auguste address intradialytic hypertension and hypotension while giving a huge shout out to the dark horse of nephrology: peritoneal dialysis.

This episode is a part of NephMadness: a nephrology educational initiative that is modeled after the college basketball tournament but with nephrology concepts. It is a noncommercial learning initiative that leverages the tools of social media to teach about the latest and greatest breakthroughs in the field of nephrology.

Participants in the PodCrawl:

The Curbsiders : An Internal Medicine Podcast…for the Internist. This episode will focus on the Cardiorenal Syndrome. Listen on Apple or Spotify.

The Drs. Washington: The Drs. Washington are three sister physicians will discuss social and physical determinants of health as well as governmental and institutional initiatives that affect health inequities in nephrology. Listen on Apple or Spotify.

The Cribsiders: On this pediatric podcast, go deep into Neonatal AKI. Listen on Apple or Spotify.

Best Science (BS) Medicine: The Best Science Medicine podcast discusses the tricky issue of albuminuria – who to monitor, what to monitor, and who to treat. Listen on Apple or Spotify.

Freely Filtered: On this nephrology podcast, the filtrate discuss comparative animal physiology (specifically nephrology). This time around they are discussing giraffe and whale kidneys. Listen on Apple or Spotify.

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Up My Nursing Game is partnering with VCU Health Continuing Education to offer FREE continuing education credits for registered nurses. Click here to obtain nursing credit (1.00).

See the show notes at upmynursinggame.com.