Table 6 Recommendations for people with type 2 diabetes on dialysis

1. We recommend that ambulatory blood pressure measurement or home blood pressure measurement should be used to monitor blood pressure in people with diabetes who are on dialysis (Grade 1C).

2. Where ambulatory blood pressure measurement or home measurement are not feasible to monitor blood pressure in people with diabetes who are on dialysis, we suggest using pre-, intra- and post-dialysis standardised blood pressure measurements for people who are on haemodialysis, and using standardised clinic blood pressure measurements for people who are on peritoneal dialysis (Grade 2D).

3. We recommend volume control as a first-line management to optimise blood pressure control in people with diabetes who are on dialysis (Grade 1B).

4. We suggest salt restriction to < 5 g per day to optimise blood pressure control in people with diabetes who are on dialysis (Grade 2C).

5. We suggest a target upright interdialytic blood pressure of < 140/90 mmHg for people with diabetes who are on dialysis. Individualisation of the blood pressure target may be indicated in other people who are burdened with multiple comorbidities, in order to reduce adverse events of blood pressure lowering (Grade 2D). For peritoneal dialysis patients we also suggest the target BP is < 140/90 mmHg (Grade 2D)

6. We recommend that intradialytic hypotension should be avoided in people with diabetes who are on haemodialysis (Grade 1B).

7. We suggest using ACEIs or ARBs (but not in combination), beta blockers and calcium channel blockers to reduce cardiovascular complications in people with diabetes and hypertension who are on dialysis (Grade 2B).

8. We suggest the use of diuretics in people with diabetes who are on dialysis and have residual renal function (Grade 2C).