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How should a person on dialysis control high blood pressure?

Q: How can I take care of my father, 73 years old, who has chronic renal failure – stage 5. Please suggest the right drug for controlling his blood pressure. He has been undergoing regular dialysis at least once weekly for the last two years. His recent laboratory tests reveal: blood urea is 160 (high), uric acid, potassium, and calcium levels are within limits. Urea creatinine is 8 and haemoglobin is 8. some months ago, it had gone down to 6 and he had to be given 4 units of blood transfusion. Two weeks back he was given another 2 units of blood transfusion and erythropoetion injections were given once a week but with not much improvement. His body weight pre-dialysis is 63 kg and post-dialysis is 61 Kg. Ideally, it should be 58 kg. He is taking the following medicines: Enam 5 mg (1 tablet twice daily), Selokane Excel 50 mg (one daily), Prazoprell Excel 5 mg (one daily), Nicaradia Retard 20 mg + 10 mg (twice daily) and Frusenex 100 mg once daily. His blood pressure target is 120/75 mmHg, however, it remains high. Please advise what blood pressure medicines he should consider taking and how should we take care of him? Also, for the last 2-3 days he is shivering as if he has high fever but there is no fever. His hands shake when he tries to eat or hold a pen. He is vomiting too.

A:The blood pressure in a dialysis patient is related to salt and water retention. A person with kidney failure should get adequate dialysis (thrice a week), should have minimal salt & water retention and if the B.P. is still high then the drugs that your father is already on should be fine. The doses of these need to be titrated to achieve the target. The maximum doses of Enam could go up to 10 mg twice daily, Seloken to 100 mg twice a day, Prazopress XL to 10 mg twice daily. However these dosages should be titrated only in consultation with the nephrologist taking care of your father.

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