Hypertension in patients on dialysis: diagnosis, mechanisms, and management

Abstract

Hypertension (blood pressure > 140/90 mm Hg) is very common in patients undergoing regular dialysis, with a prevalence of 70-80%, and only the minority has adequate blood pressure (BP) control. In contrast to the unclear association of predialytic BP recordings with cardiovascular mortality, prospective studies showed that interdialytic BP, recorded as home BP or by ambulatory blood pressure monitoring in hemodialysis patients, associates more closely with mortality and cardiovascular events. Although BP is measured frequently in the dialysis treatment environment, aspects related to the measurement technique traditionally employed may be unsatisfactory. Several other tools are now available and being used in clinical trials and in clinical practice to evaluate and treat elevated BP in chronic kidney disease (CKD) patients. While we wait for the ongoing review of the CKD Blood Pressure KIDGO guidelines, there is no guideline for the dialysis population addressing this important issue. Thus, the objective of this review is to provide a critical analysis of the information available on the epidemiology, pathogenic mechanisms, and the main pillars involved in the management of blood pressure in stage 5-D CKD, based on current knowledge.

Fasting plasma glucose, lipid ratios, and atherogenic coefficient are the risk factors for hypertension in chronic kidney disease patients on hemodialysis: A report from the Regional High Speciality Hospital of Peninsular Yucatan, Mexico

“…In the present study among CKD patients undergoing hemodialysis, high prevalence of hypertension and type 2 diabetes mellitus (T2DM) (both 63.83%) were recorded. Reports on the frequency of hypertension range between 70% and 80% globally among patients undergoing regular dialysis (Bucharles et al 2019).…”

Analysis of microRNA processing machinery gene (DROSHA, DICER1, RAN, and XPO5) variants association with end‐stage renal disease

“…As this variant is located in the miR‐27b‐binding site within 3′UTR of DROSHA, 32 substitution of A by G disrupts the interaction between miR‐27b and DROSHA, increasing the DROSHA expression, which has been associated with increased risk of primary hypertension 31 and preeclampsia 33 . As hypertension is a key player in ESRD etiopathology, with a prevalence of 70%‐80%, 34 it is reasonable to find an increased frequency of the minor allele of this variant in our samples, but not reach the level of significant association as not all enrolled patients had hypertension. This speculation will need further validation on large‐scale cohorts.…”

Analysis of risk factors for deep venous thrombosis in patients with gynecological malignant tumor: A clinical study

“…The clinical data of patients including gender, age, tumor staging, adenocarcinoma, surgery, operation time, hypertension, hyperlipemia, diabetes, coronary heart disease, radiotherapy, chemotherapy, hospital stay, and postoperative rehabilitation exercises were collected to analyze the clinical characteristics of patients and determine the risk factors of DVT. In these clinical data, hypertension was defined as blood pressure above 140/90 mmHg9, and hyperlipemia was defined as an elevated total cholesterol level above 6.22 mmol/L, or triaglyceride level above 2.26 mmol/L, or low-density lipoprotein level above 4.14 mmol/L10, and other disease such as diabetes and coronary heart disease were also diagnosed according to corresponding criteria 11,12. Most of the included patients in the current study were treated surgically, to facilitate to determine the influence of surgical treatment on the occurrence of DVT, the thrombosis occurring before or after surgery was identified clearly.…”