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Medical Associates  ·  Department of Nephrology ← Maintenance Hemodialysis  ·  urinenephrology.org
Clinical Mastery Series  ·  Maintenance Hemodialysis

Treating hypertension on dialysis: targets, trials, agents, dose timing

What the randomized evidence supports, how to reconcile KDOQI, KDIGO, and UKKA, which β-blocker to choose, and whether to hold BP medicines before a treatment.
Andrew Bland, MD, FACP, FAAP UICOMP · UDPA · Butler COM Reviewed September 2026 13 min read

Part of the Maintenance Hemodialysis mastery module. Reviewed September 2026.

Bottom line

  • Blood pressure lowering works in dialysis. Eight randomized trials (1,679 patients): cardiovascular events RR 0.71, all-cause mortality RR 0.80, cardiovascular mortality RR 0.71, for a mean separation of only 4.5/2.3 mmHg — roughly 2 deaths prevented per 100 patient-years (NNT approximately 50 per year, the authors’ estimate) 1.
  • Targeting an aggressive pre-dialysis number does not. The BID pilot produced point estimates favoring the standard arm for hospitalization (IRR 1.61) and access thrombosis (IRR 3.09), and the intensive arm got there with drugs while target weights rose 2,3.
  • Target the out-of-unit BP (<130/80 mmHg ambulatory, <135/85 mmHg home). Use the UKKA pre-dialysis systolic range of 140–165 mmHg (grade 2B) as a guardrail against overtreatment, not as a goal; UKKA sets no home-BP target 4,5. KDOQI 2015 set no BP target at all 6.
  • Sequence the treatment: sodium and volume first, dialysis prescription second, drugs third 3,7.
  • β-blocker choice is contested. Carvedilol initiation carried higher mortality than metoprolol in an observational comparison 8, and low-dialyzability agents fared better than high-dialyzability ones in another 9. The exception is heart failure with reduced ejection fraction: the only placebo-controlled survival trial of a β-blocker in dialysis used carvedilol (2-year death 51.7% vs 73.2%) 10.
  • Do not reflexively hold BP medicines before dialysis. In TAKE-HOLD, taking them was superior for uncontrolled hypertension, and UKKA now advises against omission 5,11.

1. Treat the right number

This page assumes the measurement question is settled: home BP or ambulatory monitoring is the measurement to treat, and the pre-dialysis reading is a safety and volume signal, not a target. Out-of-unit BP predicts mortality and cardiovascular events in the same patients in whom peridialytic BP does not 12,13,14, and one week of home readings detects ambulatory hypertension better than two weeks of pre-dialysis readings 15. UKKA 2025 suggests home or standardized out-of-unit BP to guide treatment and in-unit BP to judge the safety of the session (both 2C) 5. The evidence behind that choice is laid out in Which blood pressure matters: measurement and prognosis.

Everything below is about what to do once the right number is elevated: whether treatment helps, how low to go, in what order, with which drugs, and when to give them.

2. The trial evidence

2.1 Pharmacologic BP lowering reduces events

The Heerspink meta-analysis pooled 8 randomized trials, 1,679 patients, and 495 cardiovascular events. The weighted mean BP separation between arms was 4.5/2.3 mmHg 1:

OutcomeRR (95% CI)RRRAbsolute effect
Cardiovascular events0.71 (0.55–0.92), p = 0.00929%ARR not reliably derivable: heterogeneous composites, I² 67.5%, follow-up 12–36 months
All-cause mortality0.80 (0.66–0.96), p = 0.01420%ARR approximately 2 deaths per 100 patient-years; NNT approximately 50 per year (authors’ estimate at 10% annual mortality)
Cardiovascular mortality0.71 (0.50–0.99), p = 0.04429%Not reported

This is the strongest argument against therapeutic nihilism in dialysis hypertension. Read it with its limits: two of the eight trials were unpublished meeting reports, the mean Jadad score was 3.1, and heterogeneity tracked with whether heart-failure admissions were in the composite 1. A 4.5 mmHg separation producing a 29% reduction in events also suggests effects beyond BP lowering.

2.2 Targeting an aggressive pre-dialysis number carries a safety signal

BID (randomized pilot) assigned 126 patients to a standardized pre-dialysis systolic target of 110–140 mmHg (intensive) or 155–165 mmHg (standard). From months 4 to 12 the achieved separation was 12.9 mmHg 2:

Outcome, intensive vs standardResult
All-cause hospitalizationIRR 1.61 (0.87–2.97)
Vascular access thrombosisIRR 3.09 (0.96–8.78)
Major adverse cardiovascular eventsIRR 1.18 (0.40–3.33)
Deaths4 vs 1
Left ventricular mass changeSimilar

None of these estimates reached conventional significance, but the point estimates for hospitalization, access thrombosis, cardiovascular events, and deaths all leaned the same way. Two readings of BID matter more than the point estimates. First, KDIGO notes that although the protocol called for challenging the post-dialysis weight first, the intensive arm reached target with additional antihypertensives, and target weights actually rose 3. BID therefore tested drug-driven peridialytic targeting, not volume control. Second, 55% of consented patients never reached randomization 5. Small and short, BID is the only randomized test of the intensive peridialytic-target strategy in existence, and it did not favor it.

2.3 Agent choice may matter more than guidelines admit

HDPAL (randomized, open-label, single center, 86% Black) assigned 200 patients with left ventricular hypertrophy and hypertension to atenolol- or lisinopril-based therapy, both dosed thrice weekly after dialysis, both titrated to home BP <140/90 mmHg alongside dry-weight adjustment and sodium restriction 16. Ambulatory BP fell similarly and the primary endpoint, left ventricular mass, did not differ. The data and safety monitoring board stopped the trial early: serious cardiovascular events occurred at a 2.36-fold higher rate in the lisinopril arm (IRR 2.36; 95% CI 1.36–4.23), with more all-cause hospitalizations (IRR 1.61) 16.

3. Reconciling the guidelines

SourceRecommendation
KDOQI 2005Pre-dialysis <140/90, post-dialysis <130/80 mmHg: grade C, opinion-based, extrapolated from the general population 17. The 2015 KDOQI hemodialysis adequacy update addressed volume and BP control through treatment time, sodium restriction, and ultrafiltration rate but set no numeric BP target; the 2005 numbers were not formally rescinded, simply not reaffirmed 6
KDIGOThe 2021 BP-in-CKD guideline excludes patients on dialysis 18. The 2010 Controversies Conference weighed the optimal target without an evidence-based number 19. The 2020 Controversies Conference concluded that definitive BP targets cannot be recommended, urged an individualized approach “with a particular focus on avoiding overly low BPs,” and made any symptomatic fall or intradialytic nadir systolic BP <90 mmHg the trigger for reassessment 3
ERA-EDTA / ESH (EURECA-m) consensus 2017Diagnose by home BP ≥135/85 (6 days) or 44-h ABPM ≥130/80 mmHg; peridialytic J- and U-curves most likely reflect measurement inaccuracy 4
AHA Scientific Statement 2023Hypertension in more than 80% of in-center hemodialysis patients; favors out-of-unit (home or ambulatory) BP for diagnosis and management; names BP targets and treatment strategies as research priorities 20
UK Kidney Association 2025Interdialytic ABPM is the gold standard for diagnosis (1C); home or standardized out-of-unit BP to guide treatment (2C); in-unit BP for session safety, not hypertension management (2C). Where non-standardized in-centre readings are used: pre-dialysis systolic 140–165 mmHg (2B), pre-dialysis diastolic 60–100 (2C), post-dialysis systolic 120–140 and diastolic ≥70 (2C); aim for the lower end unless IDH increases (2D); lower targets for younger, less comorbid patients (2C). No home-BP target; a practice point notes that home or standardized systolic BP of approximately 130 mmHg or lower tracks with the lowest risk 5

The UKKA range deserves comment. A range of 140–165 mmHg is not a claim that 160 mmHg is healthy. It is a safety envelope for units still steering by non-standardized in-centre readings, built on the observational U-curve and the BID signal 5. The guideline itself tells clinicians to sit low in the envelope unless IDH rises, and to treat younger, less comorbid patients lower. The coherent reading of the whole evidence base:

The target

Target the out-of-unit BP (<130/80 mmHg ambulatory, <135/85 mmHg home). Use the pre-dialysis range of 140–165 mmHg as a guardrail against overtreatment, not as a goal 4,5.

4. Treatment sequencing

Because the dominant driver of hypertension in dialysis is sodium and volume excess, the order of operations follows the physiology 3,7.

  1. Sodium and volume first. Dietary salt ≤5 g/day (UKKA grade 1B) 5; dialysate sodium not exceeding plasma sodium; probe dry weight downward; and extend treatment time before increasing the ultrafiltration rate 3,7. Dry-weight probing is covered in Estimating dry weight; the rate ceiling in Ultrafiltration rate and treatment time.
  2. Dialysis prescription second. Longer sessions, more frequent sessions, or shortening the long interdialytic interval. The FHN Daily trial (randomized, 6 versus 3 sessions per week, n = 245) improved the coprimary composite of death or left ventricular mass increase (HR 0.61; 0.46–0.82), lowered pre-dialysis systolic BP by 7.7 mmHg at 2 months, and reduced antihypertensive use, at the cost of more vascular access interventions (HR 1.71) 21,22. Excess mortality and cardiovascular events cluster on the day after the two-day gap, the approximately 68-hour long interval 23.
  3. Drugs third, dosed after dialysis or in the evening where dialyzability and IDH history warrant, and chosen with intradialytic hemodynamics in mind 3,5.

Figure 1 turns that sequence into a pathway for the common situation: a peridialytic reading has been flagged as high, and someone wants to act on it.

flowchart TB
    S["Elevated pre-dialysis or<br>post-dialysis BP flagged"] --> Q1{"Out-of-unit BP<br>obtained?"}
    Q1 -->|No| A1["Obtain 44-h ABPM or<br>6-7 days home BP<br>before changing anything"]
    Q1 -->|Yes, normal| A2["Peridialytic effect only<br>No action<br>Do not reduce target weight"]
    Q1 -->|Yes, elevated| Q2{"Objective evidence<br>of volume excess?<br>B-lines, RPV slope, BIA"}
    Q2 -->|Yes| A3["Probe target weight<br>in small steps as tolerated<br>Reassess at 4 to 8 weeks"]
    Q2 -->|No or equivocal| A4["Trial of probing with<br>predefined stop rules"]
    A3 --> Q3{"UF rate stays<br>under 13 mL per kg per hour?"}
    A4 --> Q3
    Q3 -->|No| A5["Add treatment time<br>or add a session<br>Do not raise UF rate"]
    Q3 -->|Yes| Q4{"Nadir SBP under 90 in<br>30 percent or more of sessions?"}
    Q4 -->|Yes| A6["Stop probing<br>Cool dialysate, review vasodilating drugs,<br>reassess target weight upward"]
    Q4 -->|No| A7["Continue<br>Recheck out-of-unit BP<br>at 4 to 8 weeks"]
    A7 --> A8["Residual gap treated with drugs<br>dosed post-dialysis or evening<br>Target home BP under 135/85"]
    style S fill:#fff3bf,stroke:#f59f00,color:#000
    style Q1 fill:#f8f9fa,stroke:#495057,color:#000
    style Q2 fill:#f8f9fa,stroke:#495057,color:#000
    style Q3 fill:#f8f9fa,stroke:#495057,color:#000
    style Q4 fill:#f8f9fa,stroke:#495057,color:#000
    style A1 fill:#e7f5ff,stroke:#1971c2,color:#000
    style A2 fill:#b2f2bb,stroke:#2f9e44,color:#000
    style A3 fill:#d0ebff,stroke:#1971c2,color:#000
    style A4 fill:#d0ebff,stroke:#1971c2,color:#000
    style A5 fill:#fff3bf,stroke:#f59f00,color:#000
    style A6 fill:#ffc9c9,stroke:#e03131,color:#000
    style A7 fill:#b2f2bb,stroke:#2f9e44,color:#000
    style A8 fill:#b2f2bb,stroke:#2f9e44,color:#000
Figure 1. Management Pathway When a Peridialytic BP Is Elevated. Nothing changes on a peridialytic reading alone; the out-of-unit BP decides. Volume is tested by probing over 4–8 weeks, the ultrafiltration rate stays under 13 mL/kg/h by adding time, a nadir systolic BP under 90 mmHg in 30% or more of sessions stops the probing, and drugs close the residual gap. Adapted from the canonical review.

4.1 Reading the pathway

  • No out-of-unit BP yet: obtain 44-hour ABPM or 6–7 days of home BP before changing anything 4,15.
  • Home BP normal, pre-dialysis BP 190 mmHg: a white-coat or peridialytic effect. Do not add drugs and do not reduce the target weight on that basis; reassess volume objectively and recheck the out-of-unit BP.
  • The reverse — normal in-center readings, high home BP: masked hypertension, found in 14% of patients by 48-hour ABPM 24. In BID, nearly one-third of participants had home BP above their pre-dialysis BP, and that group carried more left ventricular mass 25. This is the group the in-center cuff systematically fails and the group most likely to be undertreated.
  • Out-of-unit BP elevated: look for objective evidence of volume excess, then probe the target weight in small steps with predefined stop rules and reassess at 4–8 weeks 26.
  • Target weight not reachable under 13 mL/kg/h: add treatment time or a session rather than raising the ultrafiltration rate, which is associated with higher all-cause and cardiovascular mortality above that threshold 27,28.
  • Nadir systolic BP <90 mmHg in 30% or more of sessions: stop probing, review vasodilating drugs, consider cooler dialysate, and reassess the target weight upward 3,29.
  • Residual gap: antihypertensive drugs dosed after dialysis or in the evening, to a home BP under 135/85 mmHg 4,5.

5. Agent selection

ConsiderationEvidence
β-blockade as first line in hemodialysisUKKA 2025, on BP-lowering efficacy (2B) 5; HDPAL favored atenolol over lisinopril 16
Post-dialysis thrice-weekly dosing of long-acting dialyzable agentsThe HDPAL protocol 16; UKKA suggests it for non-adherent patients (2D) 5
Avoid α-blockers and central α-agonists where possibleOrthostasis-prone; secondary choices in the absence of trial data 1
Do not reflexively withhold on dialysis daysTAKE-HOLD: taking reduced uncontrolled pre-dialysis hypertension 11; UKKA advises against omission, with evening dosing if a drug is implicated in IDH (2D) 5 (Section 6)

5.1 Which β-blocker: the evidence conflicts

Two large observational analyses point in different directions, and it is worth seeing why.

  • Carvedilol versus metoprolol (Assimon 2018, observational): initiating carvedilol, a low-dialyzability β-blocker with α1-blocking vasodilator activity, was associated with higher 1-year all-cause (adjusted HR 1.08) and cardiovascular mortality (adjusted HR 1.18) than initiating metoprolol, with more IDH as the proposed mechanism 8.
  • High versus low dialyzability (Weir 2015, observational): in older patients, high-dialyzability agents (atenolol, metoprolol, acebutolol) carried higher 180-day mortality than low-dialyzability agents, mostly bisoprolol (RR 1.4; 95% CI 1.1–1.8; NNH 71) 9. This study favors low dialyzability.
  • Guidelines split along the same line. UKKA suggests low-dialysability β-blockers generally (2C) 5; KDIGO 2020 notes it may be prudent to avoid nondialyzable agents when IDH is frequent 3.
  • Meta-analyses of observational data favor cardioselective over non-selective agents for cardiovascular events (HR 0.85; 0.81–0.89; low-to-moderate certainty) 30 and show no mortality difference by dialyzability (adjusted HR 0.91; 0.81–1.02) 31.

One way to reconcile the two headline studies is that carvedilol differs from metoprolol in more than dialyzability: it vasodilates. The working synthesis is therefore about the patient in front of you. In the IDH-prone patient, avoid carvedilol’s vasodilation and use a cardioselective agent; otherwise, dialyzability is an unresolved question 3,5,8,9. For hypertension, HDPAL’s thrice-weekly post-dialysis atenolol regimen is the randomized regimen with outcome data in its favor 16.

5.2 The HFrEF exception: carvedilol

The only placebo-controlled survival trial of a β-blocker in dialysis used carvedilol. Cice and colleagues randomized 114 dialysis patients with dilated cardiomyopathy 10:

Outcome at 2 yearsCarvedilolPlaceboEffect
All-cause death51.7%73.2%P < 0.01; ARR 21.5%; NNT approximately 5 over 2 years
Cardiovascular death29.3%67.9%—

The trial was single-center, never replicated, and pre-dates modern heart-failure therapy, and the placebo-arm mortality is extreme 10. The attempt at a definitive trial failed at the feasibility stage: in BLOCADE (randomized feasibility study), only 68% of participants tolerated carvedilol 6.25 mg twice daily in the run-in, and IDH ran 7 versus 2 events per 100 sessions after dose increases (P = 0.1) 32.

Clinical Pearl — the β-blocker synthesis

HFrEF or cardiomyopathy: carvedilol is justified by the only randomized dialysis data; manage IDH around it 10,32. Hypertension alone in an IDH-prone patient: a cardioselective agent (metoprolol or bisoprolol) 8,30.

6. Holding antihypertensives before dialysis

Withholding is common and largely evidence-free. Nearly half of hemodialysis patients (46% of 189 surveyed) report withholding at least one antihypertensive before dialysis, 70% of them on physician advice 3,33. TAKE-HOLD tested the practice directly in a cluster-randomized trial across 10 units, 131 patients, and 4 weeks 11:

Outcome: taking vs holding BP medications dosed more than once dailyResult
Asymptomatic IDH (nadir systolic <90 mmHg in ≥30% of sessions), primaryTaking not shown non-inferior: unadjusted difference 8% (95% CI −3% to 19%)
Uncontrolled hypertension (pre-dialysis systolic >160 mmHg)Taking superior: difference −15% (95% CI −28% to −1%)
Failure to achieve dry weightTaking non-inferior
Shortened sessionsTaking non-inferior

Read the primary result carefully. “Not shown non-inferior” is not “shown worse”: the confidence interval for IDH runs from 3% fewer to 19% more events with taking. The hypertension result, by contrast, has a confidence interval that excludes zero. UKKA 2025 now suggests advising patients against omitting BP medication before dialysis, and using consistent evening dosing for a drug implicated in IDH (2D) 5.

Drug timing also connects to intradialytic hypertension: a patient whose BP climbs during every treatment may simply be dialyzing off a dialyzable agent such as atenolol or lisinopril. That pattern is covered in Intradialytic hypertension and the stability trade-off.

Clinical Pearl — withholding

Reflex withholding trades a small, unproven reduction in IDH for a measurable increase in uncontrolled hypertension. Reserve it for patients with documented nadir-based IDH, apply it to the specific offending agent, and prefer evening or post-dialysis dosing over blanket omission 5,11.

Evidence gaps

  • No adequately powered trial of a BP target exists in hemodialysis. BID was a 126-patient pilot with a safety signal and no definitive answer 2; KDIGO 2020 and UKKA 2025 both list target trials as the top research need 3,5.
  • β-blocker choice: the carvedilol-versus-metoprolol and high-versus-low dialyzability analyses point in different directions, and no randomized comparison exists 8,9. The one placebo-controlled survival trial in cardiomyopathy has never been replicated, and the attempt at a definitive trial failed at the feasibility stage 10,32.
  • Holding antihypertensives: TAKE-HOLD was a 4-week, 131-patient pilot 11.
  • Volume versus drugs: whether the mortality benefit of BP lowering holds when achieved by volume rather than drugs has never been directly tested, though DRIP plus the Heerspink meta-analysis make it the most plausible reading 1,26.
  • Measurement strategy: no randomized trial has tested a home-BP-guided versus pre-dialysis-BP-guided strategy for hard outcomes; only a 50-patient, 4-month feasibility pilot exists 34.

At the chair

Chair-side summary

BP medicines on dialysis days: take them as prescribed unless the nephrologist has ordered a specific drug held or moved to the evening for that patient 5,11. Do not give a PRN antihypertensive for an asymptomatic high chair-side reading, and do not lower the target weight or raise ultrafiltration on one high pre-dialysis BP 5,12. The nursing card lists the call criteria.

Nursing card N6: Blood pressure at the chair →

References

Adapted from the author’s canonical review Blood Pressure in the Dialysis Patient (reference-checked 2026-09-26; every journal reference matched to its PubMed record). Numbering is local to this page.

  1. Heerspink HJ, Ninomiya T, Zoungas S, et al. Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials. Lancet. 2009;373(9668):1009–1015. PMID: 19249092
  2. Miskulin DC, Gassman J, Schrader R, et al. BP in dialysis: results of a pilot study. J Am Soc Nephrol. 2018;29(1):307–316. PMID: 29212839
  3. Flythe JE, Chang TI, Gallagher MP, et al; Conference Participants. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020;97(5):861–876. PMID: 32278617
  4. 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 ERA-EDTA and the Hypertension and the Kidney working group of the ESH. Nephrol Dial Transplant. 2017;32(4):620–640. PMID: 28340239
  5. Doulton T, Adam M, Durman K, et al. Management of blood pressure in adults, children and young people on dialysis: UK Kidney Association clinical practice guideline. BMC Nephrol. 2025;26(1):532. PMID: 41013409
  6. National Kidney Foundation. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update. Am J Kidney Dis. 2015;66(5):884–930. PMID: 26498416
  7. Agarwal R, Weir MR. Dry-weight: a concept revisited in an effort to avoid medication-directed approaches for blood pressure control in hemodialysis patients. Clin J Am Soc Nephrol. 2010;5(7):1255–1260. PMID: 20507951
  8. Assimon MM, Brookhart MA, Fine JP, Heiss G, Layton JB, Flythe JE. A comparative study of carvedilol versus metoprolol initiation and 1-year mortality among individuals receiving maintenance hemodialysis. Am J Kidney Dis. 2018;72(3):337–348. PMID: 29653770
  9. Weir MA, Dixon SN, Fleet JL, et al. β-Blocker dialyzability and mortality in older patients receiving hemodialysis. J Am Soc Nephrol. 2015;26(4):987–996. PMID: 25359874
  10. Cice G, Ferrara L, D'Andrea A, et al. Carvedilol increases two-year survival in dialysis patients with dilated cardiomyopathy: a prospective, placebo-controlled trial. J Am Coll Cardiol. 2003;41(9):1438–1444. PMID: 12742278
  11. Chang TI, Tatoian ET, Montez-Rath ME, Chertow GM. Timing of antihypertensive medications on key outcomes in hemodialysis: a cluster randomized trial. Kidney360. 2021;2(11):1752–1760. PMID: 35373003
  12. Agarwal R. Blood pressure and mortality among hemodialysis patients. Hypertension. 2010;55(3):762–768. PMID: 20083728
  13. Bansal N, McCulloch CE, Rahman M, et al; CRIC Study Investigators. Blood pressure and risk of all-cause mortality in advanced chronic kidney disease and hemodialysis: the Chronic Renal Insufficiency Cohort study. Hypertension. 2015;65(1):93–100. PMID: 25287404
  14. Bansal N, McCulloch CE, Lin F, et al; CRIC Study Investigators. Blood pressure and risk of cardiovascular events in patients on chronic hemodialysis: the CRIC Study (Chronic Renal Insufficiency Cohort). Hypertension. 2017;70(2):435–443. PMID: 28674037
  15. Leonidou K, Georgianos PI, Kollias A, et al. Home versus routine dialysis-unit blood pressure recordings among patients on hemodialysis. J Hum Hypertens. 2025;39(5):355–361. PMID: 40097627
  16. Agarwal R, Sinha AD, Pappas MK, Abraham TN, Tegegne GG. Hypertension in hemodialysis patients treated with atenolol or lisinopril: a randomized controlled trial. Nephrol Dial Transplant. 2014;29(3):672–681. PMID: 24398888
  17. K/DOQI Workgroup. K/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients. Am J Kidney Dis. 2005;45(4 Suppl 3):S1–S153. PMID: 15806502
  18. Kidney Disease: Improving Global Outcomes (KDIGO) Blood Pressure Work Group. KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int. 2021;99(3S):S1–S87. PMID: 33637192
  19. Levin NW, Kotanko P, Eckardt KU, et al. Blood pressure in chronic kidney disease stage 5D — report from a Kidney Disease: Improving Global Outcomes controversies conference. Kidney Int. 2010;77(4):273–284. PMID: 20016467
  20. Bansal N, Artinian NT, Bakris G, et al; American Heart Association Council on the Kidney in Cardiovascular Disease; Council on Cardiovascular and Stroke Nursing; Council on Epidemiology and Prevention. Hypertension in patients treated with in-center maintenance hemodialysis: current evidence and future opportunities: a scientific statement from the American Heart Association. Hypertension. 2023;80(6):e112–e122. PMID: 37092336
  21. FHN Trial Group; Chertow GM, Levin NW, Beck GJ, et al. In-center hemodialysis six times per week versus three times per week. N Engl J Med. 2010;363(24):2287–2300. PMID: 21091062
  22. Kotanko P, Garg AX, Depner T, et al. Effects of frequent hemodialysis on blood pressure: results from the randomized Frequent Hemodialysis Network trials. Hemodial Int. 2015;19(3):386–401. PMID: 25560227
  23. Foley RN, Gilbertson DT, Murray T, Collins AJ. Long interdialytic interval and mortality among patients receiving hemodialysis. N Engl J Med. 2011;365(12):1099–1107. PMID: 21992122
  24. Sarafidis PA, Mallamaci F, Loutradis C, et al. Prevalence and control of hypertension by 48-h ambulatory blood pressure monitoring in haemodialysis patients: a study by the European Cardiovascular and Renal Medicine (EURECA-m) working group of the ERA-EDTA. Nephrol Dial Transplant. 2019;34(9):1542–1548. PMID: 30007295
  25. Miskulin DC, Jiang H, Gul A, et al. Comparison of dialysis unit and home blood pressures: an observational cohort study. Am J Kidney Dis. 2021;78(5):640–648. PMID: 34144104
  26. Agarwal R, Alborzi P, Satyan S, Light RP. Dry-weight reduction in hypertensive hemodialysis patients (DRIP): a randomized, controlled trial. Hypertension. 2009;53(3):500–507. PMID: 19153263
  27. Flythe JE, Kimmel SE, Brunelli SM. Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int. 2011;79(2):250–257. PMID: 20927040
  28. Assimon MM, Wenger JB, Wang L, Flythe JE. Ultrafiltration rate and mortality in maintenance hemodialysis patients. Am J Kidney Dis. 2016;68(6):911–922. PMID: 27575009
  29. Flythe JE, Xue H, Lynch KE, Curhan GC, Brunelli SM. Association of mortality risk with various definitions of intradialytic hypotension. J Am Soc Nephrol. 2015;26(3):724–734. PMID: 25270068
  30. Tao S, Huang J, Xiao J, Ke G. Cardio-selective versus non-selective β-blockers for cardiovascular events and mortality in long-term dialysis patients: a systematic review and meta-analysis. PLoS One. 2022;17(12):e0279171. PMID: 36534654
  31. Yeh TH, Tu KC, Hung KC, Chuang MH, Chen JY. Impact of type of dialyzable beta-blockers on subsequent risk of mortality in patients receiving dialysis: a systematic review and meta-analysis. PLoS One. 2022;17(12):e0279680. PMID: 36584227
  32. Roberts MA, Pilmore HL, Ierino FL, et al; BLOCADE Study Collaborative Group. The β-Blocker to Lower Cardiovascular Dialysis Events (BLOCADE) feasibility study: a randomized controlled trial. Am J Kidney Dis. 2016;67(6):902–911. PMID: 26717861
  33. Haase SB, Chang S, Schiller B, Chertow GM, Chang TI. Antihypertensive medication withholding practices in hemodialysis: a survey study of patients and providers. Hemodial Int. 2018;22(3):415–418. PMID: 29436151
  34. Bansal N, Glidden DV, Mehrotra R, et al. Treating home versus predialysis blood pressure among in-center hemodialysis patients: a pilot randomized trial. Am J Kidney Dis. 2021;77(1):12–22. PMID: 32800842

Also in this module

Blood pressure, volume, and the dialysis prescription, one question per page.