Hypertension and hemodialysis

Pathophysiology and outcomes in adult and pediatric populations

Peter N. Van Buren, Jula K. Inrig

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Hypertension is prevalent in adult and pediatric end-stage renal disease patients on hemodialysis. Volume overload is a primary factor contributing to hypertension, and attaining true dry weight remains a priority for nephrologists. Other contributing factors to hypertension include activation of the sympathetic and renin-angiotensin- aldosterone systems, endothelial cell dysfunction, arterial stiffness, exposure to hypertensinogenic drugs, and electrolyte imbalances during hemodialysis. Epidemiologic studies in adults show that uncontrolled hypertension results in cardiovascular morbidity, but reveal increased mortality risk at low blood pressure, so that it remains unclear what the target blood pressure should be. Despite the lack of a definitive BP target, gradual dry weight reduction should be the first intervention for BP control. Renin-angiotensin-aldosterone system inhibitors have been shown to improve cardiovascular morbidity and mortality and are recommended as the initial pharmacologic therapy for hypertensive hemodialysis patients. Short-daily or nocturnal hemodialysis are also good therapeutic options for these patients. It is already established that hypertension in pediatric hemodialysis patients is associated with adverse cardiovascular outcomes, and there is emerging evidence that the mechanisms causing hypertension are similar to adults. Hypertension in adult and pediatric hemodialysis patients warrants aggressive management, although clinical trial evidence of a target BP that improves mortality does not currently exist.

Original languageEnglish (US)
Pages (from-to)339-350
Number of pages12
JournalPediatric Nephrology
Volume27
Issue number3
DOIs
StatePublished - Mar 2012

Fingerprint

Renal Dialysis
Pediatrics
Hypertension
Population
Renin-Angiotensin System
Mortality
Morbidity
Vascular Stiffness
Hypotension
Electrolytes
Chronic Kidney Failure
Weight Loss
Epidemiologic Studies
Endothelial Cells
Clinical Trials
Blood Pressure
Weights and Measures
Therapeutics
Pharmaceutical Preparations

Keywords

  • Cardiovascular outcomes
  • Hemodialysis
  • Hypertension
  • Pediatrics
  • Renin-angiotensin-aldosterone system

ASJC Scopus subject areas

  • Nephrology
  • Pediatrics, Perinatology, and Child Health

Cite this

Hypertension and hemodialysis : Pathophysiology and outcomes in adult and pediatric populations. / Van Buren, Peter N.; Inrig, Jula K.

In: Pediatric Nephrology, Vol. 27, No. 3, 03.2012, p. 339-350.

Research output: Contribution to journalArticle

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