Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH)

Sarafidis, P. A. et al. (2017) Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH). Nephrology Dialysis Transplantation, 32(4), pp. 620-640. (doi:10.1093/ndt/gfw433) (PMID:28340239)

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Abstract

In patients with end-stage renal disease (ESRD) treated with haemodialysis or peritoneal dialysis, hypertension is common and often poorly controlled. Blood pressure (BP) recordings obtained before or after haemodialysis display a J- or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar haemodynamic setting related to dialysis treatment. Elevated BP detected by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnoea and the use of erythropoietin-stimulating agents may also be involved. Non-pharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium and volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.

Item Type:Articles
Status:Published
Refereed:Yes
Glasgow Author(s) Enlighten ID:Mark, Dr Patrick
Authors: Sarafidis, P. A., Persu, A., Agarwal, R., Burnier, M., de Leeuw, P., Ferro, C. J., Halimi, J.-M., Heine, G. H., Jadoul, M., Jarraya, F., Kanbay, M., Mallamaci, F., Mark, P. B., Ortiz, A., Parati, G., Pontremoli, R., Rossignol, P., Ruilope, L., Van der Niepen, P., Vanholder, R., Verhaar, M. C., Wiecek, A., Wuerzner, G., London, G. M., and Zoccali, C.
College/School:College of Medical Veterinary and Life Sciences > Institute of Cardiovascular and Medical Sciences
Journal Name:Nephrology Dialysis Transplantation
Publisher:Oxford University Press
ISSN:0931-0509
ISSN (Online):1460-2385
Published Online:13 March 2017

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