Hypertension in dialysis and kidney transplant patients.
For the first time, the Canadian Hypertension Education Program has studied the evidence supporting blood pressure control in people requiring renal replacement therapy for end-stage kidney disease, including those on dialysis and with renal transplants. According to the Canadian Organ Replacement Registry's 2008 annual report, there were an estimated 33,832 people with end-stage renal disease in Canada at the end of 2006, an increase of 69.7% since 1997. Of these, 20,465 were on dialysis and 13,367 were living with a functioning kidney transplant. Thus, it is becoming more likely that primary care practitioners will be helping to care for these complex patients. With the lack of large controlled clinical trials, the consensus recommendation based on interpretation of the existing literature is that blood pressure should be lowered to below 140/90 mmHg in hypertensive patients on renal replacement therapy and to below 130/80 mmHg for renal transplant patients with diabetes or chronic kidney disease.
Division of Nephrology, St Michael's Hospital, University of Toronto, Toronto, Canada.
G V Ramesh
GV
Prasad
Marcel
M
Ruzicka
Kevin D
KD
Burns
Sheldon W
SW
Tobe
Marcel
M
Lebel
D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000008:administration & dosage*; D001795:Blood Pressure Determination / Q000379:methods; D002170:Canada; D003131:Combined Modality Therapy; D004039:Diet, Sodium-Restricted; D005260:Female; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000628:therapy*; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000009:adverse effects* / Q000379:methods; D008019:Life Style; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis / Q000009:adverse effects* / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome
D000959:Antihypertensive Agents