The invention relates to methods for improving treatment outcomes in patients undergoing
ultrafiltration.
Ultrafiltration during
hemodialysis or fluid removal can induce
sympathetic nervous system activation,
hypovolemia,
catecholamine surge, and widespread microvascular
ischemia, leading to cardiac stunning,
dialysis intolerance, and organ injury. Disclosed herein are methods of administering a therapeutically effective amount of one or more
receptor agonists of the renin-angiotensin
system (RAS), including
angiotensin II, angiotensin III, angiotensin IV, angiotensin 1-7, and / or prorenin
receptor (PRR) agonists, to maintain capillary
perfusion and prevent
ischemia. The methods reduce risk or incidence of
catecholamine surge, intradialytic hypotension,
cardiac dysfunction, and
muscle cramps, and also prevent or minimize systemic
ischemic injury to the brain, heart, kidneys, liver, and
skeletal muscle. By preserving systemic microvascular
blood flow, the disclosed methods mitigate or prevent
dialysis-associated
heart disease as well as
neurocognitive impairment, including
white matter injury, memory decline, and executive dysfunction. These approaches enable improved hemodynamic stability, achieving
ultrafiltration targets without the need to adjust
treatment goals, reducing the necessity for fluid bolus administration, aiding in reaching
dry weight, achievement of
dry weight goals, minimizing the occurrence and severity of
skeletal muscle cramps, and reduced long-term cardiovascular and neurological complications in patients receiving
ultrafiltration therapy.