ORLANDO, Fla. —Aldo J. Peixoto, MD, told the audience here at the Annual Dialysis Conference that while withholding antihypertensive medications is unnecessary, patients with severe intradialytic hypotension are the most important exception.

When Peixoto polled the audience to see if they asked patients to routinely withhold their antihypertensive medications before dialysis, at least one-third of the audience indicated they did.

Peixoto said that in an opinion piece he and colleagues wrote for Seminars in Dialysis, “in most patients we should not, perhaps with the exception of those who have significant hypotension and those whom we are actively dry weight probing, [withhold antihypertensives].”

Blood pressure medications can get in the way of dry weight probing “and I could not find any evidence to tell me that that’s true, so that goes by opinion and experience that I am pretty sure we all have,” Peixoto said.

Aldo J. Peixoto, MD

Peixoto reviewed the limited research and concluded there is no impact of withholding antihypertensive medications prior to hemodialysis in non-intradialytic hypotension-prone patients. The impact on intradialytic hypotension and the impact on overall blood pressure control is unknown.

There is, however, a concern that with a “decreased exposure to medications of potential cardiovascular relevance beyond blood pressure,” he said.

“So, is withholding blood pressure medication prior to hemodialysis a mistake? I think that since we know the practice and its impact is not well-defined; since we know that the impact of intradialytic hypotension is relatively small; since we know that its impact on intradialytic hypertension is not known; that its impact on the overall blood pressure is not known but there may be some other concerns, I would say that withholding medications prior to dialysis is unnecessary in most patients.”

Peixoto made two recommendations. First, that medications could be withheld during active dry weight probing.

Second, “as a unifier, I’d like to propose here, without evidence, that using non-dialyzable drugs dosed in the evening may be a valuable compromise,” he said. – by Joan-Marie Stiglich, ELS

Peixoto A. Mistakes we make in dialysis: We hold antihypertensives before dialysis. Presented at: Annual Dialysis Conference; March 3-6, 2018; Orlando, Fla.

Disclosure: Peixoto reports no relevant financial disclosures.