Administration of Blood Pressure Medications and Vitamins Before Dialysis

Blood Pressure Medications Before Dialysis

The American College of Cardiology and other guideline societies recommend continuing antihypertensive medications before dialysis unless the patient experiences frequent intradialytic hypotension, based on the patient's interdialytic blood pressure patterns and frequency of intradialytic hypotension 1, 2, 3
For patients with stable intradialytic blood pressure, administer all antihypertensive medications as scheduled, including on dialysis days, with a preference for longer-acting, once-daily medications to improve adherence and reduce pill burden 1, 2
For patients with frequent intradialytic hypotension, avoid nondialyzable medications and consider highly dialyzable agents, prioritizing non-medication strategies such as optimizing volume status, minimizing ultrafiltration rate, and reassessing target weight 1, 2, 4, 5, 6
For patients requiring cardioprotection, continue medications such as ACE inhibitors, ARBs, and beta-blockers even on dialysis days unless they interfere with achieving euvolemia, as these agents provide mortality benefit beyond blood pressure control alone 1, 2, 3, 7

The National Kidney Foundation recommends addressing volume status through sodium restriction, appropriate ultrafiltration, and dry weight optimization before escalating medications, as most hypertension in dialysis patients stems from volume overload rather than inadequate medication 2, 3, 4, 9
Maintain accurate, updated medication lists shared between dialysis units, primary care providers, and pharmacies, and implement structured medication reconciliation programs to reduce hospitalizations and readmissions in dialysis patients 10

Water-soluble vitamins such as B-complex and vitamin C can be given before dialysis, though some will be removed during the session, and consider post-dialysis administration to maximize retention 1, 9
Fat-soluble vitamins such as A, D, E, and K are not removed by dialysis due to protein binding and can be safely administered before dialysis without concern for removal 8