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Assessment of Vascular Function in Patients With Chronic Kidney Disease
08:50

Assessment of Vascular Function in Patients With Chronic Kidney Disease

Published on: June 16, 2014

Hypertension in end-stage renal disease: different measures and their prognostic significance

Walter H Hörl1

  • 1Division of Nephrology and Dialysis, Department of Medicine III, University of Vienna, Vienna, Austria. Walter.hoerl@meduniwien.ac.at

Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association
|August 6, 2010
PubMed

Insights

Maintaining normal fluid balance (normovolaemia) is crucial for managing high blood pressure (hypertension) in haemodialysis patients. Strict volume control through methods like ultrafiltration and salt restriction can reduce or eliminate the need for blood pressure medications.

Area of Science:

  • Nephrology
  • Cardiology
  • Internal Medicine

Background:

  • Hypertension is a significant risk factor for cardiovascular morbidity and mortality.
  • The majority of haemodialysis (HD) patients experience hypertension.
  • Accurate blood pressure (BP) assessment and target levels in HD patients lack sufficient prospective data.

Purpose of the Study:

  • To emphasize normovolaemia as the primary therapeutic target in haemodialysis patients.
  • To discuss non-pharmacological strategies for managing hypertension in HD patients.
  • To highlight the need for further research on optimal BP targets and treatments.

Main Methods:

  • Focus on achieving normovolaemia through dry-weight reduction via additional ultrafiltration.
  • Implementing daily dietary salt restriction or individually lowered dialysate sodium.
  • Considering alternative HD modalities like long, slow home HD, frequent short HD, or nocturnal HD.

Main Results:

  • Strict volume control can significantly reduce or eliminate the need for antihypertensive drug treatment.
  • Alternative HD modalities have shown potential in reducing BP and left ventricular hypertrophy.
  • Prospective data is limited, necessitating further investigation.

Conclusions:

  • Normovolaemia is the key therapeutic target for managing hypertension in haemodialysis patients.
  • Non-pharmacological interventions, particularly strict volume control, are effective.
  • Further research is required to establish optimal BP targets and therapeutic strategies.

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