Nocturnal hypoxemia, night-day arterial pressure changes and left ventricular geometry in dialysis patients

Zoccali, Carmine; Benedetto, Frank; Tripepi, Giovanni; Cambareri, Francesco; Panuccio, Vincenzo; Candela, Vincenzo; Mallamaci, Francesca; Enia, Giuseppe; Labate, C.; Tassone, F.

doi:10.1111/j.1523-1755.1998.00853.x

Cited by 116 publications

(45 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hypopneic spells during the night lead to nocturnal hypoxemia and provoke intense sympathetic arousal and an increase in nocturnal BP. 153 Table 2 summarizes the key points in the management of hypertension.…”

Section: Nonvolume-dependent Causes Of Hypertension In Dialysis Patientsmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

147

156

View full text Add to dashboard Cite

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. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

show abstract

Section: Nonvolume-dependent Causes Of Hypertension In Dialysis Patientsmentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

147

156

View full text Add to dashboard Cite

show abstract

“…In hemodialysis patients, sleep apnea and nocturnal hypoxemia have been linked to the development of sympathetic hyperactivity and left ventricular hypertrophy (11,12). Additionally, SAS has been associated with daytime sleepiness, impaired cognitive function, and poor vocational abilities.…”

mentioning

confidence: 99%

Sleep Apnea with Intermittent Hemodialysis

Chan¹

2006

Journal of the American Society of Nephrology

View full text Add to dashboard Cite

“…Hypoxemia during sleep is associated with nocturnal hypertension, left ventricular hypertrophy, impaired sympathovagal balance, and increased risk of cardiovascular complications including death (68)(69). Sleep apnea may exacerbate the infectious complications common in ESRD patients because sleep disruption and deprivation degrade immune function (26).…”

Section: Clinical Significancementioning

confidence: 99%