Pathophysiology of Hypertension in Patients on Renal Replacement Therapy

Leeuw, Peter W. de

doi:10.1159/000170170

Cited by 11 publications

(9 citation statements)

References 21 publications

(26 reference statements)

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“…Traditionally, there are two types of hypertension in CHD patients. [1,2] The first type is characterized by normal to low plasma renin activity and the possibility of decreasing high blood pressure by regulating body weight and reducing salt intake. This type of hypertension is called volume hypertension.…”

Section: Introductionmentioning

confidence: 99%

Endothelin-1 and Nitric Oxide in Patients on Chronic Hemodialysis

2008

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Aim. To establish the role of endothelin-1 and nitric oxide in the pathogenesis of hypertension in patients on chronic aemodyalisis by correlating endothelin-1 and NO plasma concentrations to the level of arterial hypertension with respect to angiotensin-converting enzyme (ACE) inhibitor therapy. Methods. We determined plasma concentrations of endothelin-1 and NO in patients on chronic hemodialysis (CHD) before and after hemodialysis treatment. The study included 30 CHD patients and 20 healthy participants as controls. Correlation to blood pressure was determined, as well as the effect of ACE inhibitors on the relationship between both endothelin-1 and NO in correlation with arterial hypertension. Main findings. Endothelin-1 plasma concentration was significantly higher in CHD patients before hemodialysis treatment than in healthy controls. Endothelin-1 plasma concentration was also significantly higher in CHD patients after hemodialysis than in healthy controls. There was a significant decrease in endothelin-1 plasma concentration after hemodialysis in comparison with its values before hemodialysis. In CHD patients, a positive correlation was found between endothelin-1 plasma concentration and systolic blood pressure after hemodialysis, irrespective of ACE inhibitors therapy. In CHD patients taking ACE inhibitors, systolic blood pressure increased with increasing endothelin-1 plasma concentration before as well as after hemodialysis. In patients taking ACE inhibitors, there was a tendency for diastolic blood pressure to increase with an increase in endothelin-1 plasma concentration after hemodialysis and to decrease with an increase in NO plasma concentration. Conclusion. NO and endothelin-1 play a significant role in etiology of the hemodynamic changes of blood pressure during the dialysis.

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Section: Introductionmentioning

confidence: 99%

Endothelin-1 and Nitric Oxide in Patients on Chronic Hemodialysis

2008

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“…Although disturbances in calcium, glucose and lipid metabolism, anemia, and uremic toxins all contribute to the cardiovascular complications, hypertension is the most important risk factor [4,5]. The pathophysiology of hypertension is complex and not fully understood [6]. An activated renin-angiotensin system and elevated hormonal and neural sympathetic activities have an important effect on blood pressure control [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Blood Pressure Control and Hemodynamic Changes in Patients on Long Time Dialysis Treatment

et al. 1998

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In dialysis patients blood pressure can be well controlled with long dialysis (3 times a week for 8 h) in contrast to a more common short dialysis regime (3 times a week for 4 h). We studied whether the good blood pressure control in patients on long dialysis as compared to patients on short dialysis was associated with a decrease in extracellular fluid volume. Two-day interdialytic ambulatory blood pressure monitoring was performed in 26 non-diabetic patients on long dialysis, in 22 patients on short dialysis, matched for the years they were on dialysis treatment, and during 24 h in 19 healthy volunteers. After full equilibration, 24 h after dialysis, echography of the inferior caval vein was performed to determine fluid state. Cardiac dimensions and stroke index were measured by echocardiography. A blood sample was drawn for the determination of electrolytes and vasoactive hormones. 73% of the patients on short dialysis were using antihypertensive medication in contrast to none of the patients on long dialysis. However, blood pressure was significantly lower in patients on long dialysis (115 ± 21/67 ± 11 mm Hg) when compared to patients on short dialysis (143 ± 26/81 ± 16 mm Hg). Indexed caval vein diameter, left ventricular diameter index, and atrial natriuretic peptide were not significantly different in patients on long dialysis compared to patients on short dialysis. Also the cardiac index was comparable in patients on long and short dialysis. However, the total peripheral resistance index was significantly lower in patients on long dialysis compared to the patients on short dialysis and normal controls. The left ventricular mass index was increased in both patients on long and short dialysis compared to controls. We conclude that patients on long dialysis have adequate blood pressure control that seems mainly to be caused by a low total peripheral resistance. These data also suggest that factors other than a lower fluid state contribute to the good blood pressure control in patients on long dialysis.

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“…In the present review, the hemodynamic impact of volume and sodium overload, and their relationship with neurohumoral mechanisms, will be discussed. In patients with end-stage renal disease (ESRD), blood pressure was found to be positively correlated with exchangeable sodium and extracellular volume (ECV) [1][2][3][4]. Especially in anephric patients, the relationship between volume status and blood pressure appears fairly linear [4,5].…”

mentioning

confidence: 99%

“…In patients with end-stage renal disease (ESRD), blood pressure was found to be positively correlated with exchangeable sodium and extracellular volume (ECV) [1][2][3][4]. Especially in anephric patients, the relationship between volume status and blood pressure appears fairly linear [4,5]. Moreover, the great majority of studies observed significant differences in the volume status, expressed in various ways, between normotensive and hypertensive dialysis patients [6][7][8][9].…”

mentioning

confidence: 99%

Role of Sodium and Volume in the Pathogenesis of Hypertension in Dialysis Patients

Kooman

Sande²,

Leunissen³

2004

Blood Purif

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Volume and sodium excess is the predominant factor in the pathogenesis of hypertension in dialysis patients. However, except for anephric patients, the relationship between volume status, blood pressure, and hemodynamics is not straightforward, but may vary between subgroups of patients. In general, the sensitivity of blood pressure to changes in the volume/sodium status appears to be increased in patients with end-stage renal disease. The blood pressure response to changes in the sodium/volume status may be influenced by disturbances in the activity of and response to various neurohumoral mechanisms, such as the renin-angiotensin and sympathetic nervous systems, Na-K-ATP-ase inhibitors, and the nitric oxide system. Regarding these aspects, there might be a parallel with salt-sensitive (essential) hypertension. Preliminary data showed a beneficial effect of sodium removal beyond changes in the volume status. Also of interest is the fact that prolonging dialysis time may improve blood pressure control without clear changes in the fluid status. It is hypothesized that a reduction in exchangeable sodium, by increased diffusive transport of sodium, in combination with increased removal of vasopressor substances, might be partly responsible for the observed blood pressure changes during long dialysis times. In conclusion, sodium and volume overload and neurohumoral factors coincide in the pathogenesis of hypertension in dialysis patients. Nevertheless, their exact relationship has not yet been elucidated and deserves further study.

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Pathophysiology of Hypertension in Patients on Renal Replacement Therapy

Cited by 11 publications

References 21 publications

Endothelin-1 and Nitric Oxide in Patients on Chronic Hemodialysis

Endothelin-1 and Nitric Oxide in Patients on Chronic Hemodialysis

Blood Pressure Control and Hemodynamic Changes in Patients on Long Time Dialysis Treatment

Role of Sodium and Volume in the Pathogenesis of Hypertension in Dialysis Patients

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