Systolic Blood Pressure Can Be Lowered by Strict Volume Control in Hemodialysis Patients

We intentionally read the article “Systolic Blood Pressure and Mortality in Chronic Hemodialysis Patients: Results of a Nationwide Italian Study” written by Losito and colleagues1 with interest. They concluded that there was a complex relationship between blood pressure (BP) and mortality in this population. They defined the demographic and dialytic characteristics of a group of patients with an inverse relationship between postdialysis systolic BP and mortality.1 Hypertension is common among patients with chronic kidney disease and often remains poorly controlled in hemodialysis patients.2 However, in the absence of prospective data, accurate assessment of BP and the level to which BP should be targeted still remain to be defined.3 Dry-weight reduction by additional ultrafiltration combined with daily dietary salt restriction or individually lowered dialysate sodium is recommended.4 Strict volume control allows marked reduction of antihypertensive drug treatment or makes it even unnecessary.5 We think there is a complex relationship between BP and mortality in dialysis patients. If strict volume control can be made, BP can be reduced without antihypertensive drug treatment. There is no conflict of interests.