TY - JOUR
T1 - Blood pressure and volume management in dialysis
T2 - conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
AU - Flythe, Jennifer E.
AU - Chang, Tara I.
AU - Gallagher, Martin P.
AU - Lindley, Elizabeth
AU - Madero, Magdalena
AU - Sarafidis, Pantelis A.
AU - Unruh, Mark L.
AU - Wang, Angela Yee Moon
AU - Weiner, Daniel E.
AU - Cheung, Michael
AU - Jadoul, Michel
AU - Winkelmayer, Wolfgang C.
AU - Polkinghorne, Kevan R.
AU - Adragão, Teresa
AU - Anumudu, Samaya J.
AU - Chan, Christopher T.
AU - Cheung, Alfred K.
AU - Costanzo, Maria Rosa
AU - Dasgupta, Indranil
AU - Davenport, Andrew
AU - Davies, Simon J.
AU - Dekker, Marijke J.E.
AU - Dember, Laura M.
AU - Gallego, Daniel
AU - Gómez, Rafael
AU - Hawley, Carmel M.
AU - Hecking, Manfred
AU - Iseki, Kunitoshi
AU - Jha, Vivekanand
AU - Kooman, Jeroen P.
AU - Kovesdy, Csaba P.
AU - Lacson, Eduardo
AU - Liew, Adrian
AU - Lok, Charmaine E.
AU - McIntyre, Christopher W.
AU - Mehrotra, Rajnish
AU - Miskulin, Dana C.
AU - Movilli, Ezio
AU - Paglialonga, Fabio
AU - Pecoits-Filho, Roberto
AU - Perl, Jeff
AU - Pollock, Carol A.
AU - Riella, Miguel C.
AU - Rossignol, Patrick
AU - Shroff, Rukshana
AU - Solá, Laura
AU - Søndergaard, Henning
AU - Tang, Sydney C.W.
AU - Tong, Allison
AU - Tsukamoto, Yusuke
PY - 2020/5
Y1 - 2020/5
N2 - Blood pressure (BP) and volume control are critical components of dialysis care and have substantial impacts on patient symptoms, quality of life, and cardiovascular complications. Yet, developing consensus best practices for BP and volume control have been challenging, given the absence of objective measures of extracellular volume status and the lack of high-quality evidence for many therapeutic interventions. In February of 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference titled Blood Pressure and Volume Management in Dialysis to assess the current state of knowledge related to BP and volume management and identify opportunities to improve clinical and patient-reported outcomes among individuals receiving maintenance dialysis. Four major topics were addressed: BP measurement, BP targets, and pharmacologic management of suboptimal BP; dialysis prescriptions as they relate to BP and volume; extracellular volume assessment and management with a focus on technology-based solutions; and volume-related patient symptoms and experiences. The overarching theme resulting from presentations and discussions was that managing BP and volume in dialysis involves weighing multiple clinical factors and risk considerations as well as patient lifestyle and preferences, all within a narrow therapeutic window for avoiding acute or chronic volume-related complications. Striking this challenging balance requires individualizing the dialysis prescription by incorporating comorbid health conditions, treatment hemodynamic patterns, clinical judgment, and patient preferences into decision-making, all within local resource constraints.
AB - Blood pressure (BP) and volume control are critical components of dialysis care and have substantial impacts on patient symptoms, quality of life, and cardiovascular complications. Yet, developing consensus best practices for BP and volume control have been challenging, given the absence of objective measures of extracellular volume status and the lack of high-quality evidence for many therapeutic interventions. In February of 2019, Kidney Disease: Improving Global Outcomes (KDIGO) held a Controversies Conference titled Blood Pressure and Volume Management in Dialysis to assess the current state of knowledge related to BP and volume management and identify opportunities to improve clinical and patient-reported outcomes among individuals receiving maintenance dialysis. Four major topics were addressed: BP measurement, BP targets, and pharmacologic management of suboptimal BP; dialysis prescriptions as they relate to BP and volume; extracellular volume assessment and management with a focus on technology-based solutions; and volume-related patient symptoms and experiences. The overarching theme resulting from presentations and discussions was that managing BP and volume in dialysis involves weighing multiple clinical factors and risk considerations as well as patient lifestyle and preferences, all within a narrow therapeutic window for avoiding acute or chronic volume-related complications. Striking this challenging balance requires individualizing the dialysis prescription by incorporating comorbid health conditions, treatment hemodynamic patterns, clinical judgment, and patient preferences into decision-making, all within local resource constraints.
KW - hemodialysis
KW - patient-reported outcome measures
KW - peritoneal dialysis
KW - quality of life
KW - residual kidney function
UR - http://www.scopus.com/inward/record.url?scp=85082851176&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2020.01.046
DO - 10.1016/j.kint.2020.01.046
M3 - Article
AN - SCOPUS:85082851176
SN - 0085-2538
VL - 97
SP - 861
EP - 876
JO - Kidney International
JF - Kidney International
IS - 5
ER -