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 (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.
Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Pantelis A
PA
Sarafidis
Pole of Cardiovascular Research, Institut de Recherche Expérimentale et Clinique, and Division of Cardiology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Alexandre
A
Persu
Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA.
Rajiv
R
Agarwal
Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland.
Michel
M
Burnier
Department of Medicine, Maastricht University Medical Center, Maastricht and Zuyderland Medical Center, Geleen/Heerlen, The Netherlands.
Peter
P
de Leeuw
Department of Renal Medicine, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
Charles J
CJ
Ferro
Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, François-Rabelais University, Tours, France.
Jean-Michel
JM
Halimi
Saarland University Medical Center, Internal Medicine IV-Nephrology and Hypertension, Homburg, Germany.
Gunnar H
GH
Heine
Division of Nephrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium.
Michel
M
Jadoul
Department of Nephrology, Sfax University Hospital and Research Unit, Faculty of Medicine, Sfax University, Sfax, Tunisia.
Faical
F
Jarraya
Department of Medicine, Division of Nephrology, Koc University School of Medicine, Istanbul, Turkey.
Mehmet
M
Kanbay
CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy.
Francesca
F
Mallamaci
Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK.
Patrick B
PB
Mark
IIS-Fundacion Jimenez Diaz, School of Medicine, University Autonoma of Madrid, FRIAT and REDINREN, Madrid, Spain.
Alberto
A
Ortiz
Department of Cardiovascular, Neural, and Metabolic Sciences, San Luca Hospital, Istituto Auxologico Italiano and Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.
Gianfranco
G
Parati
Università degli Studi and IRCCS Azienda Ospedaliera Universitaria San Martino-IST, Genova, Italy.
Roberto
R
Pontremoli
INSERM, Centre d'Investigations Cliniques Plurithématique 1433, UMR 1116, Université de Lorraine, CHRU de Nancy, F-CRIN INI-CRCT Cardiovascular and Renal Clinical Trialists, and Association Lorraine de Traitement de l'Insuffisance Rénale, Nancy, France.
Patrick
P
Rossignol
Hypertension Unit & Institute of Research i?+?12, Hospital Universitario 12 de Octubre, Madrid, Spain.
Luis
L
Ruilope
Department of Nephrology and Hypertension, Universitair Ziekenhuis Brussel - VUB, Brussels, Belgium.
Patricia
P
Van der Niepen
Nephrology Section, Department of Internal Medicine, Ghent University Hospital, Gent, Belgium.
Raymond
R
Vanholder
Department of Nephrology and Hypertension, University Medical Center Utrecht, The Netherlands.
Marianne C
MC
Verhaar
Department of Nephrology, Transplantation and Internal Medicine, Medical University of Silesia in Katowice, Katowice, Poland.
Andrzej
A
Wiecek
Service of Nephrology and Hypertension, Lausanne University Hospital, Lausanne, Switzerland.
Gregoire
G
Wuerzner
Manhes Hospital and FCRIN INI-CRCTC, Manhes, France.
Gérard M
GM
London
CNR-IFC, Clinical Epidemiology and Pathophysiology of Hypertension and Renal Diseases Unit, Ospedali Riuniti, Reggio Calabria, Italy.
Carmine
C
Zoccali
D000959:Antihypertensive Agents / Q000627:therapeutic use; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology*; D007676:Kidney Failure, Chronic / Q000628:therapy*; D017410:Practice Guidelines as Topic / Q000592:standards*; D006435:Renal Dialysis / Q000009:adverse effects*; D012955:Societies, Medical
D000959:Antihypertensive Agents
blood pressure; end-stage renal disease; haemodialysis; hypertension; peritoneal dialysis