Role of Antihypertensives in End-Stage Renal Disease: A Systematic Review

Rabbani, Rizwan; Noel, Edva; Boyle, Suzanne; Balina, Hema; Ali, Sabahat; Fayoda, Bolajoko; Khan, Waqas Ahmad

doi:10.7759/cureus.27058

Cited by 3 publications

(2 citation statements)

References 25 publications

(27 reference statements)

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“…Hypertension is commonly observed in patients with chronic kidney disease (CKD) 1) , and its prevalence varies from 60% to 90%, depending on the stage and cause of CKD 2) . In CKD, the hypertension mechanisms include sympathetic overactivity, volume overload, endothelial dysfunction, salt retention, and changes in the hormonal system(e.g., increased activity renin-angiotensin-aldosterone system[RAAS]) regulating blood pressure (BP) 2 3) .…”

Section: Introductionmentioning

confidence: 99%

Understanding and Treatment Strategies of Hypertension and Hyperkalemia in Chronic Kidney Disease

2023

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Hypertension and potassium imbalance are commonly observed in chronic kidney disease (CKD) patients. The development of hypertension would be related to several mechanisms. Hypertension is related to body mass index, dietary salt intake, and volume overload and is treated with antihypertensives. In CKD patients, managing hypertension can provide important effects that can slow the progression of CKD or reduce complications associated with reduced glomerular filtration rate. The prevalence of hyperkalemia and hypokalemia in CKD patients was similar at 15-20% and 15-18%, respectively, but more attention needs to be paid to treating and preventing hyperkalemia, which is related to a higher mortality rate, than hypokalemia. Hyperkalemia is prevalent in CKD due to impaired potassium excretion. Serum potassium level is affected by renin-angiotensin-aldosterone system inhibitors and diuretics and dietary potassium intake and can be managed by potassium restriction dietary, optimized renin-angiotensin-aldosterone system inhibitor, sodium polystyrene sulfonate, patiromer, and hemodialysis. This review discussed strategies to mitigate and care for the risk of hypertension and hyperkalemia in CKD patients.

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Section: Introductionmentioning

confidence: 99%

Understanding and Treatment Strategies of Hypertension and Hyperkalemia in Chronic Kidney Disease

2023

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“…15,16 Hypertension management principles in hemodialysis patients involve preventing excess extracellular volume through antihypertensive diuretic therapy. 17,18 Inappropriate diuretic selection can lead to resistant hypertension. Regimen modification, including diuretic addition, dose escalation, or utilization of diuretics with distinct mechanisms, is viable.…”

Section: Introductionmentioning

confidence: 99%

Therapy of resistant hypertension in patients with chronic kidney disease complications of anemia in hemodialysis: a case report

Sumarlim,

Gan,

Wuryana

et al. 2023

J. Teknol. Laboratorium

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Chronic Kidney Disease (CKD) is closely related to hypertension. Increasing the severity of CKD is associated with more difficult blood pressure control. Appropriate therapeutic management is needed to prevent complications due to uncontrolled hypertension. We report the case of a 78-year-old female patient with a diagnosis of hypertension and end-stage CKD with a history of undergoing hemodialysis for 4 years. The patient has been taking antihypertensive drugs such as Angiotensin Receptor Blockers, Calcium Channel Blockers and Diuretics. However, the administration of three antihypertensive drugs still could not help achieve the expected blood pressure target where the systolic blood pressure was still above 160 mmHg. The patient also has anemia as a common complication of chronic kidney disease. Appropriate management of therapy with fourth-line therapy and hemoglobin repair is necessary to achieve improved clinical outcomes and reduce renal worsening.

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Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs. A prospective multicenter observational study.

Mora-Bravo,

Morales,

Rojas

et al. 2024

Preprint

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Background High blood pressure is a prevalent condition in patients with chronic kidney disease on hemodialysis. Adequate control of high blood pressure is essential to reduce deaths in this group of patients. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point of care dry weight (POCW) technique. Methods The present observational, prospective study was carried out at the Pafram Hemodiafiltration Unit in Morona Santiago, Ecuador, and the Hemodialysis Unit of the Fundación Renal del Ecuador in Guayaquil, Ecuador, from August 2019 to December 2023. Patients who were receiving hemodiafiltration were included. Weight was optimized with POCW. Group 1 included patients whose antihypertensive agents were not required to control blood pressure with a value less than 150/85 mmHg predialysis at eight weeks of POCW. In group 2, the patients required antihypertensive therapy. Clinical data, demographic data, mortality data, treatment descriptions, and routine laboratory test results during dialysis were included. The sample was nonprobabilistic. Survival analysis was carried out for the study groups. The log-rank test (Mantel-Cox) was used for survival comparisons. Results The study included 106 patients. Optimal blood pressure control without antihypertensive treatment was achieved in 52 patients (49.1%) (Group 1). In 54 patients (50.9%), antihypertensive agents were required (Group 2). There was more significant mortality in the group that received antihypertensives: 11 patients in group 1 (21.2%) versus 25 patients in group 2 (46.3%) (P = 0.005). Survival was more significant in group 1, with an HR of 2.2163 (1.125–4.158) (P = 0.0243). Conclusion Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs.

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Role of Antihypertensives in End-Stage Renal Disease: A Systematic Review

Cited by 3 publications

References 25 publications

Understanding and Treatment Strategies of Hypertension and Hyperkalemia in Chronic Kidney Disease

Understanding and Treatment Strategies of Hypertension and Hyperkalemia in Chronic Kidney Disease

Therapy of resistant hypertension in patients with chronic kidney disease complications of anemia in hemodialysis: a case report

Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs. A prospective multicenter observational study.

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