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Vol 21, No 4 (2017)
REVIEW
Published online: 2017-10-19
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Pathogenesis and treatment of hypertension in haemodialysis patients with chronic kidney disease

Patrycja Pokora1, Marcin Adamczak1, Andrzej Więcek1
DOI: 10.5603/AH.a2017.0021
·
Arterial Hypertension 2017;21(4):195-204.
Affiliations
  1. Department of Nephrology, Transplantation and Internal Medicine; Medical University of Silesia, ul. Francuska 20/24, 40-027 Katowice, Poland

open access

Vol 21, No 4 (2017)
REVIEW
Published online: 2017-10-19

Abstract

Hypertension is frequently diagnosed among patients with chronic kidney disease (CKD) and often remains poorly controlled in end stage kidney disease (ESKD) especially in haemodialysis patients. These patients are characterized by higher blood pressure variability than the general population. Volume overload is a primary factor contributing into the pathogenesis of hypertension in this cohort. In the diagnosis and monitoring of hypertension in haemodialysis patients with chronic kidney disease self-measured of blood pressure at home done during the days between haemodialysis sessions should be considered. Home blood pressure measurements are of greater prognostic value than haemodialysis unit recording. Target-values of blood pressure in haemodialysis patients are still matter of debate. However, self-measured systolic blood pressure values at home between 120 to 130 mmHg are associated with the best prognosis in haemodialysis patients with CKD. Among not pharmacological methods of antihypertensive treatment in haemodialysis patients with CKD reducing volaemia by increasing ultrafiltration during haemodialysis procedures, individualization of sodium concentration in the dialysis fluid and low sodium diet should be listed. While, in the pharmacotherapy b-adrenergic antagonists seem to be the drugs of first choice.

Abstract

Hypertension is frequently diagnosed among patients with chronic kidney disease (CKD) and often remains poorly controlled in end stage kidney disease (ESKD) especially in haemodialysis patients. These patients are characterized by higher blood pressure variability than the general population. Volume overload is a primary factor contributing into the pathogenesis of hypertension in this cohort. In the diagnosis and monitoring of hypertension in haemodialysis patients with chronic kidney disease self-measured of blood pressure at home done during the days between haemodialysis sessions should be considered. Home blood pressure measurements are of greater prognostic value than haemodialysis unit recording. Target-values of blood pressure in haemodialysis patients are still matter of debate. However, self-measured systolic blood pressure values at home between 120 to 130 mmHg are associated with the best prognosis in haemodialysis patients with CKD. Among not pharmacological methods of antihypertensive treatment in haemodialysis patients with CKD reducing volaemia by increasing ultrafiltration during haemodialysis procedures, individualization of sodium concentration in the dialysis fluid and low sodium diet should be listed. While, in the pharmacotherapy b-adrenergic antagonists seem to be the drugs of first choice.

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Keywords

hypertension, haemodialysis, chronic kidney disease

About this article
Title

Pathogenesis and treatment of hypertension in haemodialysis patients with chronic kidney disease

Journal

Arterial Hypertension

Issue

Vol 21, No 4 (2017)

Pages

195-204

Published online

2017-10-19

Page views

1451

Article views/downloads

1463

DOI

10.5603/AH.a2017.0021

Bibliographic record

Arterial Hypertension 2017;21(4):195-204.

Keywords

hypertension
haemodialysis
chronic kidney disease

Authors

Patrycja Pokora
Marcin Adamczak
Andrzej Więcek

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