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Intradialytic Hypertension Sympathetic Endothelin — ESENeph MCQ

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HardHaemodialysisIntradialytic Hypertension Sympathetic EndothelinESENeph

A haemodialysis patient has a reproducible 25-mmHg systolic rise from pre- to post-dialysis despite taking long-acting antihypertensives. Bioimpedance suggests extracellular volume excess, and dialysate sodium exceeds the patient’s average pre-dialysis sodium. What is the best initial strategy?

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Correct answer: C — Reassess target weight, sodium intake and the dialysate sodium gradient

Explanation lettering: E = shown as A · C = shown as B · D = shown as C · B = shown as D · A = shown as E

D is correct. Intradialytic hypertension often reflects chronic extracellular-volume excess combined with vascular resistance and an adverse dialysate-to-serum sodium gradient. Management starts by reassessing target weight and sodium exposure, using gradual volume reduction and an individualised dialysis prescription. Medication timing and choice may then be refined, preferably with home or ambulatory readings, but simply adding a short-acting dose can obscure the volume driver. Increasing dialysate sodium may worsen thirst, interdialytic weight gain and positive sodium balance; shortening dialysis increases ultrafiltration stress and does not correct the mechanism.

Reference: UK Kidney Association haemodialysis guideline: https://guidelines.ukkidney.org/haemodialysis/