Key result
Dialysis BP targets lack firm evidence, though out-of-office monitoring provides superior prognostic value.
Why the study?
The appropriate blood pressure target for dialysis patients remains controversial due to complex relationships between BP and outcomes and lack of large clinical trial data.
Does targeting specific blood pressure levels improve cardiovascular and all-cause mortality in dialysis patients?
Does targeting specific blood pressure levels improve cardiovascular and all-cause mortality in dialysis patients?
Firm blood pressure targets for dialysis patients cannot be established based on current evidence, highlighting the need for large randomized controlled trials.
No BP targets can yet be endorsed for dialysis; leaves open the design of definitive RCTs using home or ambulatory monitoring.
The appropriate blood pressure (BP) target for dialysis patients remains controversial. Although there have been remarkable advances in this area in the general population, extrapolation of these data to dialysis patients is not possible. Observational studies in dialysis patients suggest that low BP is associated with worse outcomes. However, this is likely a result of confounding, considering that among dialysis patients with fewer cardiovascular comorbidities and longer survival, a more linear relationship exists between BP and mortality. Use of home BP measurements and ambulatory blood pressure monitoring (ABPM) measurements are more useful from a prognostic standpoint than in-center predialysis BP measurements. Large clinical trial data are, however, lacking and firm recommendations on BP targets for dialysis patients are not possible.
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McCallum et al. (2018) conducted a review in End stage kidney disease (ESKD) on dialysis. Blood pressure targets was evaluated. Blood pressure targets for dialysis patients cannot be firmly recommended based on current evidence, though home and ambulatory measurements appear more prognostic than in-center readings.
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