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)∗

Pantelis A. Sarafidis, Alexandre Persu, Rajiv Agarwal, Michel Burnier, Peter De Leeuw, Charles J. Ferro, Jean Michel Halimi, Gunnar H. Heine, Michel Jadoul, Faical Jarraya, Mehmet Kanbay, Francesca Mallamaci, Patrick B. Mark, Alberto Ortiz, Gianfranco Parati, Roberto Pontremoli, Patrick Rossignol, Luis Ruilope, Patricia Van Der Niepen, Raymond VanholderMarianne C. Verhaar, Andrzej Wiecek, Gregoire Wuerzner, Gérard M. London, Carmine Zoccali

Research output: Contribution to journalReview articlepeer-review

52 Scopus citations

Abstract

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 mechanismof 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. Nonpharmacologic 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.

Original languageEnglish (US)
Pages (from-to)620-640
Number of pages21
JournalNephrology Dialysis Transplantation
Volume32
Issue number4
DOIs
StatePublished - Apr 1 2017

Keywords

  • blood pressure
  • end-stage renal disease
  • haemodialysis
  • hypertension
  • peritoneal dialysis

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

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