HTN in ESRD patient
demo
Published on Jun 26, 2021
55-year-old gentleman with past medical history seen for hypertension, polycystic kidney disease and end-stage renal disease on dialysis for the past 4 years. He gets dialysis on a Monday Wednesday Friday schedule. Systolic blood pressure midweek on wednesday day during dialysis is 150 systolic range. His current blood pressure medications include metoprolol and amlodipine. Is currently on a 140 sodium bath with a 3-1/2-hour session of dialysis. Clinical examination shows evidence of bibasilar crackles, 1+ lower extremity edema and elevated JVD. He is not very compliant with a low-salt diet the next up in theManagement of this patient
A. Low-salt diet, achieve goal EDW by increase dialysis time with consideration of additional hemodialysis session during the week, reduce dialysate sodium to 136 over the next 3 to 4 weeks
B. Start ACE inhibitor/ARB for better blood pressure control
C. Start spironolactone.
D . Start centrally acting agent-minoxidil
