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Hypertension management in patients with advanced chronic kidney disease with and without dialysis

Maria L Gonzalez Suarez1, Jose Arriola-Montenegro, Leticia Rolón

  • 1Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minnesota, USA.

Current Opinion in Cardiology
|April 4, 2025
PubMed

Insights

Managing hypertension in advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD) requires updated strategies. New guidelines and therapies, including SGLT2 inhibitors, improve blood pressure control and cardiovascular outcomes.

Area of Science:

  • Nephrology
  • Cardiology
  • Pharmacology

Background:

  • Hypertension is a frequent comorbidity in advanced chronic kidney disease (CKD) and end-stage kidney disease (ESKD), significantly increasing cardiovascular disease risk and mortality.
  • Managing hypertension in this population is challenging due to high rates of resistant hypertension.

Purpose of the Study:

  • To review recent updates in hypertension management for patients with advanced CKD and ESKD.
  • To highlight new guidelines and emerging therapeutic options for blood pressure control in this complex patient group.

Main Methods:

  • Review of recent literature and updated KDIGO guidelines.
  • Analysis of current and novel pharmacological treatments.
  • Emphasis on lifestyle modifications and volume management in dialysis patients.

Main Results:

  • Updated KDIGO guidelines recommend lower blood pressure targets to reduce cardiovascular risks.
  • First-line therapies include diuretics, ACE inhibitors, and ARBs.
  • Novel agents like SGLT2 inhibitors, endothelin receptor antagonists, RNA interference therapeutics, and aldosterone synthase inhibitors show promise for resistant hypertension.
  • Lifestyle changes (low-salt diet, exercise) and ultrafiltration are critical for blood pressure management.

Conclusions:

  • Individualized treatment strategies combining pharmacologic and nonpharmacologic approaches are essential for optimizing blood pressure control in advanced CKD and ESKD.
  • Effective blood pressure management can improve cardiovascular outcomes and enhance patient quality of life.
Abstract

Keywords:
kidney diseasenovel antihypertensivesresistant hypertensionultrafiltration goals

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