Hypertension in Dialysis Patients

Abstract

Hypertension is a major risk for cardiovascular complications in dialysis patients. The pathogenesis of hypertension is multifactorial and is not completely understood. Hypervolemia has always been considered a major pathogenetic factor. In addition, a disturbed hormone profile with an activated renin angiotensin system, increased catecholamine, vasopressin and endothelin, and perhaps decreased nitrous oxide activity seem to play a role in the high incidence of hypertension in dialysis patients. The influence of autonomic dysfunction on blood pressure control in hemodialysis patients is not clear. The frequent use of erythropoietin during the last decade may have contributed to the increased incidence of hypertension in the dialysis population. Data from the First Report on Dialysis and Transplant in Sicily showed that hypertension is the cause of end-stage renal disease in 8% of dialysis patients and that the incidence of hypertension, as a cause of end-stage renal disease, increased with age.

Acquired cystic kidney disease and arterial hypertension in hemodialysis patients

“…Surely such a high percentage of AH among the patients included in our study is a cause for concern. At a mean duration of dialysis treatment of 4.6 years, we can no longer speak of a high prevalence of AH at the beginning of HD treatment, when it is highest (60-90%) [8,21]. AH was found in 58.8% of the men and 41.2% of the women, the difference between the sexes being statistically significant.…”

“…Departments of Internal Medicine -Department of Nephrology, Maribor Teaching Hospital, Maribor, Slovenia genesis of AH in HD patients is multilayered and at present still not completely elucidated [8,9]. The most prominent pathogenetic factor of AH in HD patients is hypervolemia [8,9].…”

“…The most prominent pathogenetic factor of AH in HD patients is hypervolemia [8,9]. The evaluation of hypervolemia depends on the estimation of the so-called dry weight.…”

Blood Pressure and Hemodialysis

“…Furthermore, patients treated with the angiotensin-converting enzyme inhibitor lisinopril have a dose-dependent increase in plasma renin activity and an improvement in blood pressure ). Patients whose blood pressure is not controlled by maintenance of dry weight have increased plasma renin activity and demonstrate a dramatic improvement in hypertension control after interruption of the renin-angiotensin axis by bilateral nephrectomy (Bellinghieri et al, 1999).…”

“…It occurs more commonly in those people with preexisting hypertension, a positive family history of hypertension, rapid correction of anemia, or with severe anemia (Ishimitsu et al, 1993, Lebel et al, 1994, Bellinghieri et al, 1999. Nearly one third of renal failure patients treated with erythropoietin develop an increase in blood pressure of 10 mmHg or more (Eschbach et al, 1989).…”