Article

Hypertension control with daily dialysis.

Division of Nephrology, University of New Mexico, Albuquerque, New Mexico 87131, USA.
Seminars in Dialysis (impact factor: 2.27). 17(4):295-8. DOI:10.1111/j.0894-0959.2004.17330.x pp.295-8
Source: PubMed

ABSTRACT Hypertension is present in 60-90% of patients on maintenance hemodialysis (HD) and it is an important cause of cardiovascular (CV) mortality and morbidity. Frequent and prolonged HD has been uniformly shown to control hypertension in end-stage renal disease (ESRD) patients more effectively than conventional HD. The etiology of hypertension is predominantly volume dependent, but in a subset of patients increased renin, sympathetic overactivity, and endothelial dysfunction may play a role. Intradialytic hypotension precludes attainment of dry weight and hence optimal control of hypertension in conventional HD is challenging. Frequent and prolonged dialysis with gentle and persistent ultrafiltration allows time for refilling of the intravascular compartment and permits normalization of extracellular volume. It is also possible that intensive dialysis enables removal of pressor molecules and improves endothelial function. Improved blood pressure control translates into regression of left ventricular hypertrophy in patients on daily HD. Thus prolonged and frequent dialysis permits better control of hypertension via volume and volume-independent mechanisms and also improves cardiac geometry.

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    Article: Hypertension in chronic kidney disease: navigating the evidence.
    F M Tedla, A Brar, R Browne, C Brown
    [show abstract] [hide abstract]
    ABSTRACT: Hypertension is both an important cause and consequence of chronic kidney disease. Evidence from numerous clinical trials has demonstrated the benefit of blood pressure control. However, it remains unclear whether available results could be extrapolated to patients with chronic kidney diseases because most studies on hypertension have excluded patients with kidney failure. In addition, chronic kidney disease encompasses a large group of clinical disorders with heterogeneous natural history and pathogenesis. In this paper, we review current evidence supporting treatment of hypertension in various forms of chronic kidney disease and highlight some of the gaps in the extant literature.
    International journal of hypertension. 01/2011; 2011:132405.
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Keywords

cardiac geometry
 
control hypertension
 
dry weight
 
end-stage renal disease
 
endothelial dysfunction
 
endothelial function
 
ESRD
 
extracellular volume
 
frequent dialysis permits
 
Improved blood pressure control translates
 
intensive dialysis enables removal
 
Intradialytic hypotension precludes attainment
 
intravascular compartment
 
maintenance hemodialysis
 
permits normalization
 
persistent ultrafiltration
 
subset
 
sympathetic overactivity
 
ventricular hypertrophy
 
volume-independent mechanisms