Blood pressure management in children on dialysis

Research output: Contribution to journalArticlepeer-review

Abstract

Hypertension is a leading cause of cardiovascular complications in children on dialysis. Volume overload and activation of the renin–angiotensin–aldosterone system play a major role in the pathophysiology of hypertension. The first step in managing blood pressure (BP) is the careful assessment of ambulatory BP monitoring. Volume control is essential and should start with the accurate identification of dry weight, based on a comprehensive assessment, including bioimpedance analysis and intradialytic blood volume monitoring (BVM). Reduction of interdialytic weight gain (IDWG) is critical, as higher IDWG is associated with a worse left ventricular mass index and poorer BP control: it can be obtained by means of salt restriction, reduced fluid intake, and optimized sodium removal in dialysis. Optimization of peritoneal dialysis and intensified hemodialysis or hemodiafiltration have been shown to improve both fluid and sodium management, leading to better BP levels. Studies comparing different antihypertensive agents in children are lacking. The pharmacokinetic properties of each drug should be considered. At present, BP control remains suboptimal in many patients and efforts are needed to improve the long-term outcomes of children on dialysis.

Original languageEnglish
Pages (from-to)239-250
Number of pages12
JournalPediatric Nephrology
Volume33
Issue number2
DOIs
Publication statusPublished - 2018

Keywords

  • Blood pressure
  • Blood volume monitoring
  • Children
  • Dialysis
  • End-stage renal disease
  • Sodium overload
  • Volume overload

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Nephrology

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