45 year old patient on hemodialysis with uncontrolled hypertension

A 45-year-old patient on hemodialysis for one week has noted that his blood pressure is more difficult to control. He reports good compliance with his medications, which include erythropoietin, ferrous sulfate, vancomycin, and vitamin D. His blood pressure is 180/99 mm Hg. Which of the following is the most likely cause for the worsening control of his blood pressure?

  1. Erythropoietin
  2. Ferrous sulfate
  3. Vancomycin
  4. Vitamin D
  5. Uremia

The correct answer is 1. Erythropoetin

The patient most likely has a worsening of his blood pressure due to erythropoietin. This is seen in about 33% of dialysis patients.

Vitamin D (choice 4), iron (choice B) and vancomycin (choice 3) generally do not raise blood pressure.

The patient is now on dialysis and should not be uremic (choice 5).

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Dr. Lawrence Kindo

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