Table 1.

Ten controversies in hypertension in dialysis patients

One view	Opposing view
1 Ambulatory or home BP monitoring is not feasible more most patients throughout the world. Predialysis and postdialysis BP measurements should remain standards by which patients are treated for hypertension.	Home BP is feasible for most patients on dialysis and should be routinely performed by most. Peridialytic BP recordings should be abandoned for making decisions regarding hypertension management in dialysis patients.
2 Goal BP recommended by KDOQI work group should remain standards by which patients should be treated.	These standards are obsolete given new studies. They should be abandoned.
3 Patients should be evaluated if they have normal BP, since it is they who carry excess cardiovascular risk.	Hypertension diagnoses by home BP monitoring should be treated.
4 Observational studies can guide treatment decisions among dialysis patients.	These studies cannot draw a cause and effect relationship and many randomized trials in nephrology have failed to confirm observational data.
5 ACE inhibitors or Ang II antagonist should be administered to all patients. Dry-weight should come next.	Volume control should be the primary method of managing these patients.
6 Patients on dialysis should be fluid restricted.	There is no role for fluid restriction. Dialysate sodium and dietary salt restriction can be useful to facilitate achievement of dry-weight in these patients.
7 Longer treatment times are required to improve volume state	Volume state can be improved even with standard 4-hour dialysis provided attention is paid to hemodynamic stability.
8 BP drop can lag weeks or months after lowering dry weight	There is little evidence for lag phenomenon among prevalent dialysis patients.
9 Intradialytic blood volume monitoring cannot detect fluid-overload.	Intradialytic blood volume monitoring is useful to judge dry weight.
10 Antihypertensive medications should be held before dialysis	Antihypertensive medications are long-acting and there is little role for holding them prior to dialysis.