TY - JOUR
T1 - Blood pressure and volume management in dialysis
T2 - conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
AU - Flythe, Jennifer E.
AU - Chang, Tara I.
AU - Gallagher, Martin P.
AU - Lindley, Elizabeth
AU - Madero, Magdalena
AU - Sarafidis, Pantelis A.
AU - Unruh, Mark L.
AU - Wang, Angela Yee Moon
AU - Weiner, Daniel E.
AU - Cheung, Michael
AU - Jadoul, Michel
AU - Winkelmayer, Wolfgang C.
AU - Polkinghorne, Kevan R.
AU - Adragão, Teresa
AU - Anumudu, Samaya J.
AU - Chan, Christopher T.
AU - Cheung, Alfred K.
AU - Costanzo, Maria Rosa
AU - Dasgupta, Indranil
AU - Davenport, Andrew
AU - Davies, Simon J.
AU - Dekker, Marijke J.E.
AU - Dember, Laura M.
AU - Gallego, Daniel
AU - Gómez, Rafael
AU - Hawley, Carmel M.
AU - Hecking, Manfred
AU - Iseki, Kunitoshi
AU - Jha, Vivekanand
AU - Kooman, Jeroen P.
AU - Kovesdy, Csaba P.
AU - Lacson, Eduardo
AU - Liew, Adrian
AU - Lok, Charmaine E.
AU - McIntyre, Christopher W.
AU - Mehrotra, Rajnish
AU - Miskulin, Dana C.
AU - Movilli, Ezio
AU - Paglialonga, Fabio
AU - Pecoits-Filho, Roberto
AU - Perl, Jeff
AU - Pollock, Carol A.
AU - Riella, Miguel C.
AU - Rossignol, Patrick
AU - Shroff, Rukshana
AU - Solá, Laura
AU - Søndergaard, Henning
AU - Tang, Sydney C.W.
AU - Tong, Allison
AU - Tsukamoto, Yusuke
AU - Watnick, Suzanne
AU - Weir, Matthew R.
AU - Wetmore, James B.
AU - Wilkie, Caroline
AU - Wilkie, Martin
AU - for Conference Participants
N1 - Funding Information:
JEF declared having received consultancy fees from AstraZeneca and Fresenius Kidney Care North America; having served on the advisory board of NxStage Medical; having received speaker honoraria from American Renal Associates, American Society of Nephrology, Dialysis Clinic, Inc., National Kidney Foundation, and multiple universities; and having received research support from Renal Research Institute, a subsidiary of Fresenius Kidney Care North America. TIC declared having received consultancy fees from Janssen Research & Development, LLC and Novo Nordisk; is expected to receive fees from Tricida, Vascular Dynamics, Inc., and Gilead Sciences for future consultancy work; declared having served on the advisory board of Fresenius Medical Care Renal Therapies Group, LLC; and declared having received research support from Satellite Health Care. MPG declared having received speaker honoraria from AstraZeneca. EL declared having received speaker honoraria from Fresenius Medical Care Asia Pacific. MM declared having received research support from Fundacion Gonzalo Rio Arronte. MLU declared having received research support from Dialysis Clinic, Inc., the National Institute of Diabetes and Digestive and Kidney Diseases, and the Patient-Centered Outcomes Research Institute. AY-MW declared having received speaker honoraria from Fresenius Kabi and Sanofi Renal; and travel support from Fresenius Kabi. DEW declared having received consultancy fees from Janssen Biopharmaceuticals and Tricida. MJ declared having received consultancy fees from Amgen, AstraZeneca, Mundipharma, MSD, and Vifor Fresenius Medical Care; speaker honoraria from Amgen, Menarini, MSD, and Vifor Fresenius Medical Care; and research support from Amgen, MSD, and Otsuka. WCW declared having received consultancy fees from Akebia, AMAG, Amgen, AstraZeneca, Bayer, Daichii-Sankyo, Relypsa, and ZS Pharma; speaker honoraria from FibroGen; and research support from the National Institutes of Health. KRP declared having received consultancy fees from Medtronic Australasia Pty Ltd. All the other authors declared no competing interests.
Funding Information:
The conference was sponsored by Kidney Disease: Improving Global Outcomes (KDIGO) and was in part supported by unrestricted educational grants from AstraZeneca, Baxter, Boehringer Ingelheim, Fresenius Medical Care, Maltron, NxStage, and Rockwell Medical. We thank Jennifer King, PhD, for assistance with manuscript preparation.
Publisher Copyright:
© 2020 International Society of Nephrology
Copyright:
Copyright 2020 Elsevier B.V., All rights reserved.
PY - 2020/5
Y1 - 2020/5
N2 - 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.
AB - 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.
KW - hemodialysis
KW - patient-reported outcome measures
KW - peritoneal dialysis
KW - quality of life
KW - residual kidney function
UR - http://www.scopus.com/inward/record.url?scp=85082851176&partnerID=8YFLogxK
U2 - 10.1016/j.kint.2020.01.046
DO - 10.1016/j.kint.2020.01.046
M3 - Article
C2 - 32278617
AN - SCOPUS:85082851176
SN - 0085-2538
VL - 97
SP - 861
EP - 876
JO - Kidney International
JF - Kidney International
IS - 5
ER -