17 March 2025

A new UKKA guideline has been published on managing blood pressure in dialysis patients

The UK Kidney Association (UKKA) has published a new Clinical Practice Guideline: Management of Blood Pressure in Adults, Children and Young People on Dialysis - a significant step forward in standardising care for dialysis patients. This is one of the first comprehensive guidelines of its kind globally, developed by a multi-professional team including nephrologists, pharmacists, dietitians and patient representatives.

Addressing a Critical Need

Cardiovascular disease remains a leading cause of mortality in dialysis patients, with hypertension being a key modifiable risk factor. Despite its impact, there has been a lack of structured guidance on blood pressure (BP) management in this population. This new UKKA guideline aims to close that gap, providing evidence-based recommendations tailored to the needs of adults, children and young people on haemodialysis and peritoneal dialysis.

Key Recommendations

The guideline covers multiple aspects of blood pressure management, including:

  • BP Measurement: Interdialytic ambulatory BP monitoring (ABPM) is recommended as the gold standard, with home BP measurement (HBPM) and standardised clinic BP readings suggested for ongoing monitoring.

  • BP Targets: A pre-dialysis systolic BP of 140-165 mmHg and post-dialysis systolic BP of 120-140 mmHg are suggested ranges for haemodialysis patients.

  • Lifestyle Modifications: Salt reduction to a maximum intake of 5g per day and regular exercise are advised to support BP control.

  • Dialysis and Dialysate Adjustments: Extended dialysis hours and modifications such as dialysate temperature lowering can help reduce intradialytic hypotension (IDH) and improve BP stability.

  • Medication Use: Beta-blockers (βBs) are suggested as first-line therapy for hypertension in haemodialysis patients, with ACE inhibitors (ACEi) positioned as third-line due to risks of hypotension.

  • Children and Young People: BP should be targeted below the 90th percentile for age, height and sex, with 24-hour ABPM used where feasible.

A Multi-Professional Approach

Developed through rigorous literature review and consensus, this guideline reflects input from a range of healthcare professionals working in kidney care, ensuring its relevance and practical application in clinical settings. The recommendations aim to promote a standardised approach to blood pressure management, improving patient outcomes and reducing variability in care.

Looking Ahead

The UKKA will continue to review and update guidelines based on emerging evidence, with this BP guideline scheduled for review in 2028. The full guideline is now available to access and implement in clinical practice.

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