HTN in ESRD patient

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3 years ago

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

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