Hypertension Considerations in the Hemodialysis Patient: What Data and Experience Reveal


With George Bakris, MD

Professor of Medicine, University of Chicago Medicine, Chicago, IL

With numerous publications to his credit on the topic of kidney disease and hypertension, Dr. Bakris delivers a well-informed perspective on identifying and treating hypertension in dialysis patients.

His presentation cites the three related systems that contribute to hypertension in dialysis patients and how dysfunction in these systems leads to the patient becoming salt sensitive.1 Rather than focusing on dialysate sodium, he points to dietary sodium as a more critical concern relative to BP.1,2

To control and treat hypertension, he outlines how certain classes of drugs work better in dialysis patients than in the general population.3,4 For example, combining a beta-blocker with clonidine doesn’t make sense in a patient with normal kidneys, but may in a subset of dialysis patients.5-7 He then shares what medication combinations he has found to be effective.

Dr. Bakris also discusses the issue of volume overload and its impact on blood pressure control.1 In his words: “The patients that get referred to me are all the patients that they can’t control. And, of course, the number one reason they can’t control them is they’re still volume overloaded.” Finally, he shares his opinion on the value of short, daily dialysis. With so many dialysis patients considered hypertensive, this presentation is a must see for any clinician looking to help control blood pressure, decrease bill burden, and reduce risk.

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  1. Sarafidis PA, Persu A, Agarwal R, et al. Hypertension in dialysis patients: A consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension. Nephrol Dial Transplant. 2017;32(4):620-640. doi:10.1093/ndt/gfw433
  2. Basile C, Pisano A, Lisi P, Rossi L, Lomonte C, Bolignano D. High versus low dialysate sodium concentration in chronic haemodialysis patients: A systematic review of 23 studies. Nephrol Dial Transplant. 2016;31(4):548-563. doi:10.1093/ndt/gfv084
  3. Genovesi S, Boriani G, Covic A, et al. Sudden cardiac death in dialysis patients: different causes and management strategies. Nephrol Dial Transplant. 2021;36(3):396-405. doi:10.1093/ndt/gfz182
  4. Roehm B, Gulati G, Weiner DE. Heart failure management in dialysis patients: Many treatment options with no clear evidence. Semin Dial. 2020;33(3):198-208. doi:10.1111/sdi.12878
  5. Hundemer GL, Sood MM, Canney M. Β-Blockers in Hemodialysis: Simple Questions, Complicated Answers. Clin Kidney J. 2020;14(3):731-734. doi:10.1093/ckj/sfaa249
  6. List I. Lexicomp® Drug Interactions. Published online 2021:6-7.
  7. Hoye NA, Wilson LC, Jardine DL, Walker RJ. Sympathetic overactivity in dialysis patients—Underappreciated and clinically consequential. Semin Dial. 2019;32(3):255-265. doi:10.1111/sdi.12756