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.

中文翻译：

---

透析中的血压和容量管理：肾脏疾病：改善全球成果 (KDIGO) 争议会议的结论。

血压 (BP) 和容量控制是透析护理的关键组成部分，对患者症状、生活质量和心血管并发症有重大影响。然而，鉴于缺乏细胞外容量状态的客观测量以及许多治疗干预措施的高质量证据，制定血压和容量控制的共识最佳实践一直具有挑战性。2019 年 2 月，肾脏疾病：改善全球结果 (KDIGO) 举办了题为“透析中的血压和容量管理”的争议会议，以评估与血压和容量管理相关的知识现状，并确定改善临床和患者报告结果的机会接受维持性透析的个体。讨论了四个主要主题：血压测量、血压目标和次优血压的药物管理；透析处方，因为它们与血压和容量有关；细胞外量评估和管理，重点是基于技术的解决方案；以及与容量相关的患者症状和经历。演讲和讨论的首要主题是，管理透析中的血压和容量涉及权衡多种临床因素和风险考虑因素以及患者的生活方式和偏好，所有这些都在狭窄的治疗窗口内，以避免急性或慢性容量相关并发症。要实现这种具有挑战性的平衡，需要将共病健康状况、治疗血流动力学模式、临床判断和患者偏好纳入决策中，从而个性化透析处方，所有这些都在当地资源限制的范围内。