How to control hypertension in Dialysis patients!
Dr. Venkatesh, Consultant Nephrologist, Apollo Dialysis Clinics, Chennai
A universally common factor that leads to high blood pressure is high cholesterol. However, high blood pressure is also seen to occur in dialysis patients as a post dialysis complication. Characteristics of high BP in dialysis patients vary from those that are seen in the general population, making it difficult for doctors to detect and treat the condition. This also makes the dialysis process itself more challenging.
BP levels and BP variability need to be evaluated against target BP levels as suggested by doctors. Since BP levels are also mainly associated with cardiovascular mortality, the methods of measuring blood pressure in dialysis patients need special attention. BP monitoring should be done on 3 levels, before, during, and after dialysis. Methods of Ambulatory monitoring and home BP measurement are recommended for this.
High blood pressure can be taken care of with fluid level management, dietary salt restriction, and dry weight (body weight after dialysis) optimisation.
Fluid level management: Fluid balance and high blood pressure are directly associated with each other. High blood pressure is caused in dialysis patients when there is excessive fluid in the body. The fluid imbalance also causes swelling of the ankles and legs. So, as the first line of treatment, maintaining fitting volumes of body fluids is prescribed. Sticking to prescribed fluid allowance (amount of water intake allowed in 24 hours). Additionally, as a self precautionary measure, one needs to maintain fluid levels by breaking even the amount of fluid excretion and intake.
Dietary salt restriction: Reducing the salt intake in one’s diet is vital in the case of high blood pressure. Dialysis patients should adopt a low-sodium diet by avoiding direct salt intake, seasoning, sauces, salty snacks, dairy products, processed foods, and canned goods. A dietician can help patients figure out the right diet plan.
Dry weight optimization: Maintaining an ideal dry weight after dialysis is important to keep a check on body fluids and therefore blood pressure. Keeping a watch over fluid intake and following a kidney-friendly diet is something a dialysis patient needs to do to maintain dry weight. It is recommended to avoid salty foods for another reason, salt retains excess water in the body. Keeping track of weight everyday weight is also crucial, this helps in noticing sudden weight gain/loss between sessions and notifying the doctor. Necessary measures can be taken to resolve any such occurrence by changing the dry weight with dialysis.
Check on Medication: Dialysis patients are also prescribed to consume non-dialyzable antihypertensive medications in order to lower high blood pressure. Such medicines will not be absorbed out of the body through dialysis. Dialysis patients need calcium intake to maintain the balance of bone metabolism. If there is a high concentration of calcium, it can get deposited in the blood vessels and lead to high blood pressure and ultimately heart disease. Hence, it is recommended not to ingest high amounts of calcium and have an imbalanced calcium dialysate concentration.
In addition to this, achieving sufficient removal of salts from the body (sodium) during dialysis is to be primarily considered by the doctor.
