title: Pathogenesis and management of intradialytic hypertension.
abstract: Hypertension is common in chronic kidney disease patients especially in those undergoing hemodialysis (HD). Usually, blood pressure falls after the HD session but in some patients a paradoxical increase has been observed during or immediately after HD. This phenomenon is referred as intradialytic hypertension. HD patients with intradialytic hypertension or increased blood pressure during HD present higher cardiovascular (CV) morbidity and mortality rates. The underlying mechanism of intradialytic hypertension is multifactorial. Activation both of renin-angiotensinaldosterone system (RAAS) and sympathetic nervous system, volume and sodium overload with concomitant increase in cardiac output, and endothelial dysfunction have been implicated in the pathogenesis of intradialytic hypertension. Given the lack of clinical trials regarding the pathophysiology and management of intradialytic hypertension, current treatment strategies are based mainly on experts' opinion. The purpose of this review is to describe the pathophysiology of intradialytic hypertension and discuss current strategies in order to improve intradialytic blood pressure management and concomitant HD patients' outcomes.
authors.forename: Periklis
authors.initials: P
authors.lastname: Dousdampanis
authors.forename: Kostantina
authors.initials: K
authors.lastname: Trigka
authors.forename: Argiris
authors.initials: A
authors.lastname: Giannopoulos
authors.affiliation: Hemodialysis Unit Kyanos Stavros Patras, Greece. dousdampanis@yahoo.gr.
authors.forename: Costas
authors.initials: C
authors.lastname: Fourtounas
mesh_terms: D000818:Animals; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017763:Autonomic Denervation; D001794:Blood Pressure; D005440:Fluid Therapy; D006801:Humans; D006973:Hypertension / Q000175:diagnosis / Q000209:etiology* / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D007668:Kidney / Q000294:innervation / Q000378:metabolism / Q000503:physiopathology*; D007674:Kidney Diseases / Q000150:complications / Q000378:metabolism / Q000503:physiopathology / Q000628:therapy*; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D016896:Treatment Outcome; D014882:Water-Electrolyte Balance
chemical_list: D000959:Antihypertensive Agents