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).
In patients with end-stage renal disease treated with hemodialysis or peritoneal dialysis, hypertension is very common and often poorly controlled. Blood pressure (BP) recordings obtained before or after hemodialysis display a J-shaped or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar hemodynamic setting related with dialysis treatment. Elevated BP 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 apnea and the use of erythropoietin-stimulating agents may also be involved. Nonpharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium-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.
aDepartment of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece bPole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique cDivision of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium dDepartment of Medicine, Indiana University School of Medicine eRichard L. Roudebush Veterans Administration Medical Center, Indianapolis, Indiana, USA fService of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland gDepartment of Medicine, Maastricht University Medical Center, Maastricht hZuyderland Medical Center, Geleen, The Netherlands iDepartment of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK jService de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, François-Rabelais University, Tours, France kSaarland University Medical Center; Internal Medicine IV - Nephrology and Hypertension, Homburg, Germany lDivision of Nephrology, Cliniques universitaires Saint-Luc, Université catholique de Louvain, Brussels, Belgium mDepartment of Nephrology, Sfax University Hospital nResearch Unit, Faculty of Medicine, Sfax University, Sfax, Tunisia oDivision of Nephrology, Department of Medicine, Koc University School of Medicine, Istanbul, Turkey pCNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy qInstitute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK rIIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and REDINREN, Madrid, Spain sDepartment of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano tDepartment of Medicine and Surgery, University of Milano-Bicocca, Milan uUniversità degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino IST, Genova, Italy vINSERM, Centre d'Investigations Cliniques Plurithématique 1433, UMR 1116, Université de Lorraine, CHRU de Nancy wF-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists, Nancy, France xHypertension Unit & Institute of Research i+12, Hospital Universitario 12 de Octubre, Madrid, Spain yDepartment of Nephrology and Hypertension, Universitair Ziekenhuis Brussel - VUB, Brussels zNephrology Section, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium aaDepartment of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, The Netherlands bbDepartment of Nephrology, Transplantation and Internal Medicine Medical University of Silesia in Katowice, Katowice, Poland ccManhes Hospital and FCRIN INI-CRCTC, Manhes, France.
Pantelis A
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Persu
Rajiv
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C
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JM
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Gunnar
G
Heine
Michel
M
Jadoul
Faical
F
Jarraya
Mehmet
M
Kanbay
Francesca
F
Mallamaci
Patrick B
PB
Mark
Alberto
A
Ortiz
Gianfranco
G
Parati
Roberto
R
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Patrick
P
Rossignol
Luis
L
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P
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Raymond
R
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Marianne C
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D006801:Humans; D006973:Hypertension / Q000150:complications / Q000503:physiopathology / Q000517:prevention & control / Q000628:therapy; D006435:Renal Dialysis / Q000009:adverse effects / Q000379:methods; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy