Hypertension In Dialysis Patients Research Articles

HIGH BLOOD PRESSURE IN HEMODIALYSIS: PREVALENCE AND PROGRESSION

Objective: High blood pressure (hypertension) is frequently found in chronic hemodialysis patients. It affects the prognosis by increasing the morbidity and mortality of patients. The objective of our study was to assess the prevalence of hypertension and to study its evolutionary profile in chronic hemodialysis patients at the University Hospital of Béjaia Design and method: This is a three-year retrospective cross-sectional study of 40 patients who have been chronic hemodialysis patients for at least one year and are over 18 years of age. For each patient, we recorded age, sex, initial nephropathy, date of start of hemodialysis, blood pressure balance, fluid status and different treatments prescribed. Results: We included 40 haemodialysis patients: 24 men and 16 women. The average age of our population was 54.37± 15.33 years. The duration of hemodialysis was 08.17± 7.5 years. High blood pressure was found in 67.5%. All of our patients were on antihypertensive therapy at the start of dialysis. After 3 years of evolution, 55% of patients had reached the blood pressure target, 30% had a correct blood pressure without any therapy and 15% had not reached the blood pressure targets despite triple therapy. Blood pressure balance in dialysis patients; Of course, it depends on adherence to treatment and hygienic and dietary rules, but also on effective dialysis and strict control of fluid balance in order to fight against volo-dependent hypertension. Conclusions: The control of hypertension in dialysis patients is essential and must include, in addition to adherence to treatment and dietary rules, adequate dialysis and strict control of dry weight, which must be assessed and adjusted periodically.

Hypertension on Dialysis Patients: Influence Factor and Management

Background: Hypertension remains prevalent and challenging to manage in patients with chronic kidney disease, even with renal replacement therapy. This phenomenon arises from a variety of components that contribute to and create an intricate process of interaction, which can impact the regulation of blood pressure in patients undergoing dialysis. The main goal of this overview is to find the influence factor of blood pressure in dialysis patients and investigate ways to better control their blood pressure by incorporating these factors.Methods: The literature searches using online databases such as PubMed and Google Scholar. Results: After doing an online search, we found 32 articles were relevant to this review topic. Discussion: There are additional elements that contribute to hypertension in dialysis patients, including excessive volume, heightened arterial rigidity, stimulation of the renin-angiotensin-aldosterone system, sleep apnea, activation of the sympathetic nervous system, and the administration of recombinant erythropoietin.Conclusion: Enhanced comprehension of the numerous variables at issue can effectively enhance blood pressure regulation in this group of individuals.

Prevalence and factors associated with uncontrolled blood pressure in dialysis patients using antihypertensive: a narrative review

Hypertension in patients with end-stage chronic kidney disease undergoing hemodialysis is difficult to control leading to a significant risk factor for a cardiovascular event. The aimed of this review is to summarize the prevalence of uncontrolled blood pressure in dialysis patients. This review hopefully can serve as a valuable reference and source of insight for clinicians in their efforts to attain controlled blood pressure in dialysis patients. The relevant literatures was undertaken from PubMed, Scopus, and Google Scholar for studies addressing the factor associated with uncontrolled blood pressure in hemodialysis patients using antihypertensives from 2013 to 2023. Combinations of search terms were "uncontrolled" and "blood pressure" and "dialysis" and "antihypertensive”. Any study in English, including randomized control trials, cohort, case-control, and cross-sectional studies was included. Uncontrolled blood pressure is very common among hypertension in dialysis patients (28.7 - 78.33% of cases). Factors affecting blood pressure in dialysis patients include age, obesity, and comorbidity (diabetes and stage of chronic kidney disease). Although the relationship between gender, the number of antihypertensive, the number of dialysis, and the length of dialysis sessions with blood pressure varies, some studies have shown a positive association.

Hypertension in Dialysis Patients: Diagnostic Approaches and Evaluation of Epidemiology.

Whereas hypertension is an established cardiovascular risk factor in the general population, the contribution of increased blood pressure (BP) to the huge burden of cardiovascular morbidity and mortality in patients receiving dialysis continues to be debated. In a large part, this controversy is attributable to particular difficulties in the accurate diagnosis of hypertension. The reverse epidemiology of hypertension in dialysis patients is based on evidence from large cohort studies showing that routine predialysis or postdialysis BP measurements exhibit a U-shaped or J-shaped association with cardiovascular or all-cause mortality. However, substantial evidence supports the notion that home or ambulatory BP measurements are superior to dialysis-unit BP recordings in diagnosing hypertension, in detecting evidence of target-organ damage and in prognosticating the all-cause death risk. In the first part of this article, we explore the accuracy of different methods of BP measurement in diagnosing hypertension among patients on dialysis. In the second part, we describe how the epidemiology of hypertension is modified when the assessment of BP is based on dialysis-unit versus home or ambulatory recordings.

Uncertainties in BP management in dialysis patients.

Hypertension in dialysis patients is extremely common. In this article, we review the current evidence for blood pressure (BP) goals in hemodialysis patients, and consider the effectiveness of interventions by which BP may be lowered, including manipulation of dietary and dialysate sodium; optimization of extracellular water; prolongation of dialysis time; and antihypertensive medication. Although two meta-analyses suggest lowering BP using antihypertensive drugs might be beneficial in reducing cardiovascular events and mortality, there are insufficient rigorously designed trials in hypertensive hemodialysis populations to determine preferred antihypertensive drug classes. We suggest aiming for predialysis systolic BP between 130 and 159mm Hg, while at the same time acknowledge the significant limitations of the data upon which it is based. We conclude by summarizing current knowledge as regards management of hypertension in the peritoneal dialysis population and make recommendations for future research in this field.

Serum asymmetric-dimethylarginine, apelin and NT-pro BNP levels in dialysis patients.

The relationships among serum Apelin, Asymmetric- dimethylarginine (ADMA), N-terminal probrain natriureticpeptide (NT-proBNP) levels, and blood pressures in dialysis patients are not well known. Age and sex matched 30 hemodialysis (HD), 30 peritoneal dialysis (PD) patients, and 20 healthy controls were recruited. Serum apelin-36, ADMA, NT-proBNP levels, and blood pressures of both patients and healthy controls were measured and compared. Serum ADMA and Apelin levels in HD patients were significantly higher than in PD patients. In multiple regression analyses the predictors of higher serum apelin levels were higher BMI, higher ADMA and lower systolic blood pressure. The predictors of serum ADMA levels were being on HD. The predictors of serum NT-proBNP levels were lower serum albumin and higher systolic blood pressure. Being on HD is a predictor of high ADMA levels. HD might be less effective on ADMA removal than PD. It seems that higher serum apelin levels related with lower sytolic blood pressure levels, whereas higher NT-proBNP levels related with higher sytolic blood pressure levels indicating potential roles as independent prognostic factors for systolic hypertension in dialysis patients.

Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH).

In patients with end-stage renal disease (ESRD) treated with haemodialysis or peritoneal dialysis, hypertension is common and often poorly controlled. Blood pressure (BP) recordings obtained before or after haemodialysis display a J- or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar haemodynamic setting related to dialysis treatment. Elevated BP detected by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnoea and the use of erythropoietin-stimulating agents may also be involved. Non-pharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium and volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.

Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH).

In patients with end-stage renal disease treated with hemodialysis or peritoneal dialysis, hypertension is very common and often poorly controlled. Blood pressure (BP) recordings obtained before or after hemodialysis display a J-shaped or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar hemodynamic setting related with dialysis treatment. Elevated BP by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnea and the use of erythropoietin-stimulating agents may also be involved. Nonpharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium-volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.

Assessment of Anti Hypertensive Drugs In Ckd Patients

Hypertension is common in hemodialysis patients and can often be difficult to control. Considering the high cardiovascular burden in hemodialysis patients, control of blood pressure is important to improve outcomes. This study is conducted to assess the anti hypertensive drugs treatment in chronic kidney disease (CKD) patients. This is a prospective observational study and includes information regarding CKD patients with co-morbidities like T2DM and HTN and it is conducted among 15 patients which were of both males and females of above 20 yrs of age upto 80 yrs. For these 15 patients e GFR is calculated and stage of severity of CKD was found. Patients with T2DM and Hypertensive are mostly diagnosed with CKD. Loop diuretic (Furosemide)+ calcium channel blocker (Amlodipine) this combination is prescribed more which is found to be safe for CKD patients as for this combination dosage adjustment is not required. In our study among 15 CKD patients 7 dialysis patients were included, majority of the patients have controlled SBP with the anti- hypertensive combinations. acute myocardial infarction 1-3 . They remain the firstline therapy for patients with cardiovascular (CV) disease. Similarly, in patients with diabetic and non-diabetic kidney disease, several large trials have demonstrated their effectiveness in reducing proteinuria and delaying progression of chronic kidney disease. The major adverse effects associated with ACEI and ARB use are hyperkalemia, decrease in glomerular filtration rate (GFR), and erythropoietin resistance. The risk of hyperkalemia increases with the degree of decrease in GFR in the nondialysis population 4 . The most common pattern of BP in dialysis patients is systolic hypertension associated with a wide pulse pressure due to atherosclerotic arterial stiffness. The main pathogenic mechanisms of hypertension in dialysis patients. Extracellular fluid overload is the most common feature in hypertensive dialysis patients. Indeed, insufficient volume removal is often the major factor responsible for dialysis-refractory hypertension 5-9

PC132. Using Cephalic or Axillary Vein to Femoral Vein Bypass as Surgical Treatment of Symptomatic Venous Hypertension in Dialysis Patients With Central Venous Occlusion

PC132. Using Cephalic or Axillary Vein to Femoral Vein Bypass as Surgical Treatment of Symptomatic Venous Hypertension in Dialysis Patients With Central Venous Occlusion

Highlights of the 2015 ERA-EDTA congress: chronic kidney disease, hypertension.

This paper reports the highlights in the field of chronic kidney disease (CKD) and hypertension of the last European Renal Association (ERA-EDTA) Congress (London, May 21-24, 2016). The items include an European survey on CKD epidemiology and a multicenter, open-label, randomized controlled trial on the effect of renal denervation for hypertension management. Furthermore, a polar view regarding ABPM for the diagnosis and the monitoring of hypertension in dialysis patients is presented.

P-043: Hypertension and end stage renal disease requiring hemodialysis

Background The prevalence of hypertension (HT) remains high in hemodialysis patients ranging from 55% to 85%. Its origins are in the extracellular volume overload associated to the increased arterial resistance. The aim of our study was to describe the epidemiological, clinical and therapeutic characteristics in our hypertensive hemodialysis population. Methods This was a cross-sectional descriptive study about 61 hemodialysis patients between May and August 2014. The collected data were age, type of initial renal disease, hemodialysis duration and treatment of HT. Results Of these 61 patients undergoing hemodialysis, 58 were hypertensive when hemodialysis was started, 49 were hypertensive since the discovery of the initial renal disease, and 45 patients required antihypertensive treatment after at least 6 months of hemodialysis at the end of the study. The average age of hypertensive patients was 56 years (22-88 years). 36 patients were males. The mean duration of renal replacement therapy was 7.9 years (1-31 years). In patients who started hemodialysis with HT, the initial nephropathy was a glomerulopathy in 23 cases, including 15 cases of diabetic nephropathy, vascular nephropathy in 13 cases, tubulointerstitial in 10 cases (including 2 cases of polycystic kidney disease) and in 10 cases renal disease was indeterminate. Sixty patients used at least one antihypertensive treatment during their followed in renal replacement. Seventeen hemodialysis patients had left ventricular hypertrophy and 4 had presented an ischemic stroke. Conclusions Hypertension in chronic hemodialysis patients is common. Hypertension is a risk factor for cardiovascular disease which is the main cause of morbidity and mortality in the dialysis population. The extra-cellular volume expansion is the main pathophysiological determinant of hypertension in dialysis patients. To manage hypertension, limiting dietary intake, and individualizing dialysate sodium delivery would be the first steps. Antihypertensive drug therapies can effectively reduce blood pressure and are needed by the vast majority of hemodialysis patients.

Moderator's view: Ambulatory blood pressure monitoring and home blood pressure for the prognosis, diagnosis and treatment of hypertension in dialysis patients.

Major health agencies now recommend the systematic application of ambulatory blood pressure monitoring (ABPM) for the diagnosis of hypertension. Given the exceedingly high prevalence of nocturnal hypertension, masked and white coat hypertension and the overt inadequacy of peridialysis (pre-, intra- and post-dialysis) BP measurements, more extensive application of ABPM for the diagnosis of hypertension in dialysis patients would appear logical. In a recent survey performed in NDT Educational, organizational problems and/or cognitive resistance emerged as important factors hindering more extensive application of ABPM and home BP by nephrologists. External validation of observations made in landmark studies in a single institution about hypertension subcategorization by ABPM is urgently needed. Furthermore, apparent cognitive resistance by nephrologists may be justified by the fact that these techniques have been insufficiently tested in the dialysis population for applicability in everyday clinical practice, tolerability, organizational impact and cost-effectiveness. We should be more resolute in abandoning peridialysis measurements for diagnosing and treating hypertension in haemodialysis patients. Home BP is a formidable educational instrument for patient empowerment and self-care, and evidence exists that this technique is superior to peridialysis values to better hypertension control as defined on the basis of ABPM. We should strive to promote more extensive application of home BP monitoring to diagnose and manage hypertension in haemodialysis patients. ABPM with novel, user friendly and better tolerated techniques is to be awaited in the near future.

Total Body Water and Failure to Control Blood Pressure by Medication in Hemodialysis Patients

Background: Volume overload is the main factor responsible for the pathogenesis of hypertension in dialysis patients. Few studies have evaluated the interpretation of the parameters obtained by bioelectrical impedance (BIA) to manage these patients. The aim of this study was to assess the best cutoff level of volume overload obtained by BIA able to predict the absence of hypertension control in hemodialysis patients. Methods: Volume overload was calculated as the difference between total body water (TBW) measured by bioimpedance and TBW estimated by the Watson formula in chronic stable hemodialysis patients. Inadequate control of blood pressure (BP) was defined as the mean of measurements obtained before five hemodialysis sessions ≥140 × 90 mm Hg. The best cutoff level of volume overload assessed by BIA able to predict the absence of BP control in patients on chronic hemodialysis was determined by the receiver operating characteristic (ROC) curve using the Youden method. Results: We included 205 patients, 53% male, aged 56 ± 14.5 years. The largest area under the ROC curve was found for predialysis volume overload (0.660, 95% CI 0.556-0.765, p = 0.004). The ROC curve of postdialysis volume overload also reaches statistical significance. The best cutoff point was found for predialysis volume overload ≥1.4 liters with a sensitivity of 69% and a specificity of 67%. Conclusion: The association of TBW and inadequate BP control highlights the importance of volume management in hemodialysis patients. Predialysis volume overload of 1.4 liters was the parameter that best discriminated the presence of inadequate BP control.

Assessment and management of hypertension in patients on dialysis.

Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD.

Efficacy of axillary-to-femoral vein bypass in relieving venous hypertension in dialysis patients with symptomatic central vein occlusion

Central vein stenosis or occlusion remains an unfortunate complication associated with the use of dialysis catheters. In patients with a functioning arteriovenous fistula, central vein stenosis can lead to debilitating arm, breast, or neck swelling. Treatment typically involves central vein angioplasty or stenting, or both, but restenosis and reocclusion rates remain high. Presented here are the initial results of a unique series of patients with a mature arteriovenous access and symptomatic upper extremity venous hypertension who were treated with axillary vein-to-femoral vein bypass after endovascular therapy failed. This was a retrospective analysis of 10 hemodialysis patients with a functioning right upper extremity access who underwent axillary vein-to-femoral vein bypass between December 2011 and April 2013. The 10 patients (seven men) were a median age of 58 years. All patients had documentation of prior central venous catheter placement and had undergone a previous endovascular procedure that was unsuccessful or technically unfeasible. The median hospital stay was 2 days (range, 1-3 days), and the median assisted-primary patency was 197 days (25th-75th percentile, 114-240 days). Three patients presented with recurrent arm swelling that was successfully managed in one patient with revision of the proximal anastomosis. Three additional patients presented with subsequent lower extremity swelling, with one patient benefitting from femoral vein angioplasty. Ultimately, six patients continued to use their original access, and two required placement of interval central venous catheters for hemodialysis. In patients who have exhausted all endovascular options, axillary-to-femoral vein bypass may represent a safe and efficacious approach to alleviate extremity swelling while simultaneously salvaging a functional dialysis access.

High blood pressure in dialysis patients: cause, pathophysiology, influence on morbidity, mortality and management.

Dialysis is initiated in a patient with End stage renal disease. The recent guidelines suggest the initiation of dialysis when symptoms and signs of kidney failure are present and not merely a decrease in GFR. The most common complication postdialysis is the occurrence of hypotension. However many dialysis patients are found to be hypertensive. In this article, we mention the cause and pathophysiology of hypertension in dialysis patients and its management.

Efficacy of Axillary to Femoral Vein Bypass in Relieving Venous Hypertension in Dialysis Patients with Symptomatic Central Vein Occlusion

Efficacy of Axillary to Femoral Vein Bypass in Relieving Venous Hypertension in Dialysis Patients with Symptomatic Central Vein Occlusion

The 50th anniversary of haemodialysis in Krakow, Poland.

The 50th anniversary of haemodialysis in Krakow, Poland.

Intradialytic Hypertension: An Under-recognized Cardiovascular Risk Factor. What is the Evidence?

Hypertension occurring during the course of dialysis is an increasingly recognized finding in ESRD patients treated with hemodialysis. In this review, we will describe the epidemiologic, observational, and experimental studies that have increased our understanding of the natural history, health consequences, pathophysiology, and potential prevention and treatment strategies for intradialytic hypertension. The observational evidence has led to the development of definitions of intradialytic hypertension that are validated in longitudinal cohort studies and are predictive of future health consequences from untreated intradialytic hypertension. The epidemiologic studies have demonstrated that intradialytic hypertension occurs much more commonly in ESRD patients treated with hemodialysis than previously appreciated. A number of lines of evidence support the view that intradialytic hypertension is an important independent risk factor for cardiovascular disease and for premature death. This body of evidence is discussed in the context Hill criteria for causation where intradialytic hypertension might be considered a harmful exposure causally linked to the development of cardiovascular disease. The majority of the Hill criteria are met supporting the view of a causal link. A number of laboratories using experimental and translational models have begun to elucidate the mechanisms that may mediate the intradialytic hypertension observed in a subset of hemodialysis patients. We shall review the emerging understanding of the epidemiology and pathophysiology that has led to the identification and validation of biomarkers of vascular dysfunction and/or dysregulation in patients exhibiting intradialytic hypertension. We shall review the evidence from short-term experimental trials evaluating potential interventions to treat or prevent this condition. To date, these studies have evaluated the effects of interventions on biomarkers of vascular dysfunction, on hormonal mediators of endothelial tone, and on intra- and interdialytic blood pressures in the short term. We shall review recommendations that can be justified by this new evidence and the limitations of this evidence in informing treatment. The lack of long-term RCT patient-centered outcome studies is particularly problematic when attempting to estimate the long-term benefits from treatment. Current recommendations which remain largely empiric include those for more robust surveillance for intradialytic hypertension and for its treatment, more focus on avoidance of volume overload and on avoidance of significant electrolyte imbalances during hemodialysis where these fluid and electrolyte imbalances may cause intradialytic hypertension, and more selectivity in medication choice for the pharmacologic management of hypertension in dialysis patients.