Hypertension Management in Transition: From CKD to ESRD

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Internal Medicine

Background:

• Hypertension affects approximately 90% of patients with late-stage chronic kidney disease (CKD).
• Limited data exist regarding hypertension management during the critical transition from CKD Stage 4 to Stage 5 (end-stage kidney disease).

Purpose of the Study:

• To propose a management strategy for hypertension in patients transitioning between CKD Stages 4 and 5.
• To adapt existing principles for managing advanced CKD to this specific patient group.

Main Methods:

• Applying principles from CKD Stage 5 hypertension management to the CKD Stage 4-5 transition.
• Utilizing out-of-office blood pressure (BP) monitoring, such as home BP monitoring.
• Emphasizing sodium restriction and preferential use of renin-angiotensin system blockers and diuretics.
• Considering the role of beta blockers in managing hypertension during this transition.

Main Results:

• The proposed approach integrates established management strategies for advanced CKD.
• Focuses on practical methods like home BP monitoring and medication classes.
• Addresses the need for tailored BP goals and lifestyle modifications.

Conclusions:

• A combined management approach, incorporating principles from CKD Stage 5, is recommended for hypertension during the CKD Stages 4-5 transition.
• Key strategies include out-of-office BP monitoring, appropriate medication choices (RAS blockers, diuretics, beta blockers), and sodium restriction.
• This approach aims to optimize blood pressure control in a vulnerable patient population.