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Published on: July 3, 2013
Hypertension in end-stage renal disease
1Department of Medicine, Atlanta Veterans Administration Medical Center, Georgia, USA. martinem@ohsu.edu
Kidney International. Supplement
|December 5, 1998
Summary
Hypertension is common in patients with moderate to severe renal disease, especially end-stage renal disease (ESRD). Key factors include volume expansion, renin-angiotensin system, and sympathetic overactivity.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Hypertension Research
Background:
- Moderate to severe renal disease is strongly associated with a high incidence of hypertension.
- Patients with end-stage renal disease (ESRD) frequently develop hypertension, irrespective of the primary renal pathology.
- Glomerular diseases and autosomal dominant polycystic kidney disease confer particular vulnerability to hypertension in ESRD.
Purpose of the Study:
- To investigate the multifactorial causes of hypertension in patients with end-stage renal disease.
- To explore the physiological mechanisms underlying ESRD-related hypertension.
- To review the roles of various systems and molecules in the development of high blood pressure in renal disease.
Main Methods:
- Review of existing evidence and literature on renal disease and hypertension.
- Analysis of the contribution of extracellular volume expansion.
- Examination of the renin-angiotensin system and sympathetic nervous system activity.
- Consideration of the roles of endothelin-1, nitric oxide, vasodilators, and ion channels.
Main Results:
- ESRD hypertension is primarily driven by extracellular volume expansion.
- Increased or inappropriate activation of the renin-angiotensin system contributes significantly to ESRD hypertension.
- Overactivity of the sympathetic nervous system is a key factor in hypertension associated with end-stage renal disease.
Conclusions:
- Hypertension in end-stage renal disease is a complex condition resulting from multiple interconnected pathophysiological mechanisms.
- Volume control, modulation of the renin-angiotensin system, and sympathetic tone are critical therapeutic targets.
- Further research into the roles of endothelin-1, nitric oxide, and ion channels may reveal novel treatment strategies for ESRD hypertension.
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