Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
Por:
Flythe J.E., Chang T.I., Gallagher M.P., Lindley E., Madero M., Sarafidis P.A., Unruh M.L., Wang A.Y.-M., Weiner D.E., Cheung M., Jadoul M., Winkelmayer W.C., Polkinghorne K.R., Adragão T., Anumudu S.J., Chan C.T., Cheung A.K., Costanzo M.R., Dasgupta I., Davenport A., Davies S.J., Dekker M.J.E., Dember L.M., Gallego D., Gómez R., Hawley C.M., Hecking M., Iseki K., Jha V., Kooman J.P., Kovesdy C.P., Lacson E., Jr., Liew A., Lok C.E., McIntyre C.W., Mehrotra R., Miskulin D.C., Movilli E., Paglialonga F., Pecoits-Filho R., Perl J., Pollock C.A., Riella M.C., Rossignol P., Shroff R., Solá L., Søndergaard H., Tang S.C.W., Tong A., Tsukamoto Y., Watnick S., Weir M.R., Wetmore J.B., Wilkie C., Wilkie M.
Publicada:
1 ene 2020
Categoría:
Nephrology
Resumen:
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. © 2020 International Society of Nephrology
Filiaciones:
Flythe J.E.:
University of North Carolina Kidney Center, Division of Nephrology and Hypertension, Department of Medicine, UNC School of Medicine, Chapel Hill, NC, United States
Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, NC, United States
Chang T.I.:
Division of Nephrology, Stanford University School of Medicine, Palo Alto, CA, United States
Gallagher M.P.:
George Institute for Global Health, Renal and Metabolic Division, Camperdown, Australia
Concord Repatriation General Hospital, Department of Renal Medicine, Sydney, Australia
Lindley E.:
Department of Renal Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
Madero M.:
Department of Medicine, Division of Nephrology, National Institute of Cardiology “Ignacio Chávez”, Mexico City, Mexico
Sarafidis P.A.:
Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Unruh M.L.:
Department of Internal Medicine, University of New Mexico School of Medicine, Albuquerque, NM, United States
Wang A.Y.-M.:
Department of Medicine, Queen Mary Hospital, University of Hong Kong, Hong Kong, Hong Kong
Weiner D.E.:
William B. Schwartz Division of Nephrology, Tufts Medical Center, Boston, MA, United States
Cheung M.:
KDIGO, Brussels, Belgium
Jadoul M.:
Department of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium
Winkelmayer W.C.:
Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
Polkinghorne K.R.:
Department of Nephrology, Monash Health, Clayton, Melbourne, Australia
Department of Medicine, Monash University, Clayton, Melbourne, Australia
Department of Epidemiology and Preventive Medicine, Monash University, Prahan, Melbourne, Australia
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