Blood Pressure control for Dialysis Patients



The beauty about science is that it is ever-changing. If fresh evidence is found that contradicts well-established theories, science will easily discard the old theory and adopt a new theory that better explains the new evidence. While this is great in many ways, you can never be too sure of your current theories. In Medicine this is all the more troublesome because you are dealing with lives here. Doctors could be treating you based on the currently available evidence. However, at some point in the future, they could well realise that the treatment was based on flawed premises. Where does that leave the patient?

Take Anemia Management in Dialysis patients for instance. There have been a number of studies that have revised the target Hemoglobin range among Dialysis patients. So for a few years everyone was using 10 - 12 g/dL as the target range. Then suddenly there was evidence that revised this range to 9 to 10.5!

Nephron Power covers the same issue with respect to Blood Pressure (BP) targets. In two posts (which you can read here and here , Hillel Sternlicht MD describes the timeline of how targets for BP have changed over the years. These posts talk about BP targets in general and a brief mention about early CKD stages. In Dialysis, there is the additional complexity of BP medication getting filtered out during a dialysis session (more about this here).

How should these ever-changing targets be made sense of? Should one disregard the changes and go with common sense? Should one keep up with every new piece of research and update practice accordingly? Dr. Sternlicht concludes rather beautifully:

“... the challenge of our times is to relinquish some of our clinical autonomy in order to integrate (complex) treatment algorithms. The oncology community has been at the vanguard of leveraging these developments. With distinct chemotherapeutic regimens based on the hormonal and genetic profiles of phenotypically similar cancers, they have come to appreciate that this “complexity” is the foundation of precision medicine.”

So, like so many things in medicine, one-size-fits-all is hardly the answer. Tailoring the target BP by individual could be a starting point in solving this problem. If you are on dialysis and your BP is not under control, you should talk to your nephrologist about the various options available and try to bring it under control. Discuss the possibility of your drugs getting filtered out. Discuss if another type of BP drugs needs to be added.

Remember, BP control is a very critical aspect of heart health. Several dialysis patients succumb to heart failure and cardiac arrests. Poor BP control contributes significantly to heart problems. So, do all you can to keep your BP under check. Never give up and accept high BPs as a part of life. It is impossible to find solutions solely by relying on the internet and Facebook groups. A combination of study of internet articles, peer advice from Facebook groups and most importantly a healthy discussion with your nephrologist is a good way to begin to address the problem.

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