| [ Summary ] |
Hemodialysis patients often present with abnormal blood pressure (BP), which leads to a poor prognosis. In an effort to understand the diverse underlying pathogenetic mechanisms, the first step is determining primary contributory factors. A palliative correction of the present BP value leads to little improvement of mortality. Dialysis patients are prone to overhydration, and thus, dry weight (DW) assessment is crucial for lowering BP. In addition to cardiothoracic ratio measured using a chest radiograph and evaluation for the presence of subcutaneous edema, inferior vena caval diameter measured with echocardiography and plasma levels of human atrial natriuretic peptide are of great use. Medication is not the first-line of antihypertensive and should be considered after achieving an adequate DW level. Additionally, dialysis hypotension including intradialytic hypotension, orthostatic hypotension, and sustained hypotension, is a poor prognostic factor. In particular, intradialytic hypotension is associated with degree of BW increment between dialysis days. Management of sustained hypotension might prove to be the greatest clinical challenge. Counseling regarding lifestyle modifications such as appropriate dietary restrictions, self-measurement of home BP, and assessment of nutritional status in patients could provide important benefits for improving impaired BP control. Therefore, effective collaboration between nurses, dieticians, and clinical engineers is required. |