Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association–European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH)*
Pantelis Sarafidis,Alexandre Persu,Rajiv Agarwal,Michel Burnier,Peter W. de Leeuw,Charles J. Ferro,Jean-Michel Halimi,Gunnar H. Heine,Michel Jadoul,Faical Jarraya,Mehmet Kanbay,Francesca Mallamaci,Patrick B. Mark,Alberto Ortiz,Gianfranco Parati,Roberto Pontremoli,Patrick Rossignol,Luis M. Ruilope,Patricia Van der Niepen,Raymond Vanholder,Marianne C. Verhaar,Andrzej Wiecek,Grégoire Wuerzner,Gérard M. London,Carmine Zoccali +24 more
TLDR
An overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.Abstract:
In patients with end-stage renal disease (ESRD) treated with haemodialysis or peritoneal dialysis, hypertension is common and often poorly controlled. Blood pressure (BP) recordings obtained before or after haemodialysis display a J- or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar haemodynamic setting related to dialysis treatment. Elevated BP detected by home or ambulatory BP monitoring is clearly associated with shorter survival. Sodium and volume excess is the prominent mechanism of hypertension in dialysis patients, but other pathways, such as arterial stiffness, activation of the renin-angiotensin-aldosterone and sympathetic nervous systems, endothelial dysfunction, sleep apnoea and the use of erythropoietin-stimulating agents may also be involved. Non-pharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium and volume excess, the use of antihypertensive agents is necessary. Drug treatment in the dialysis population should take into consideration the patient's comorbidities and specific characteristics of each agent, such as dialysability. This document is an overview of the diagnosis, epidemiology, pathogenesis and treatment of hypertension in patients on dialysis, aiming to offer the renal physician practical recommendations based on current knowledge and expert opinion and to highlight areas for future research.read more
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Atherosclerosis in Chronic Kidney Disease: More, Less, or Just Different?
Jose M. Valdivielso,Diego Rodríguez-Puyol,Julio Pascual,Clara Barrios,Marcelino Bermúdez-López,Maria Dolores Sanchez-Niño,María Pérez-Fernández,Alberto Ortiz +7 more
TL;DR: The NEFRONA study prospectively assessed the prevalence and progression of subclinical atherosclerosis (plaque in vascular ultrasound), confirming an increased prevalence in patients with moderate CKD and the adjusted odds ratio for subclinical Atherosclerosis increased with CKD stage, suggesting a contribution of CKD itself to subclinical atheism.
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Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference
Jennifer E. Flythe,Tara I. Chang,Martin Gallagher,Elizabeth Lindley,Magdalena Madero,Pantelis Sarafidis,Mark Unruh,Angela Yee-Moon Wang,Daniel E. Weiner,Michael Cheung,Michel Jadoul,Wolfgang C. Winkelmayer,Kevan R. Polkinghorne +12 more
TL;DR: The overarching theme resulting from presentations and discussions was that managing BP and volume in dialysis involves weighing multiple clinical factors and risk considerations as well as patient lifestyle and preferences, all within a narrow therapeutic window for avoiding acute or chronic volume-related complications.
Journal ArticleDOI
Exercise Training and Outcomes in Hemodialysis Patients: Systematic Review and Meta-Analysis.
TL;DR: A systematic review and meta-analysis of published randomized controlled trials that evaluated the effects of no <8 weeks’ exercise training on the physical fitness outcomes for adults with end-stage renal disease undergoing hemodialysis found aerobic exercise and combined exercise were the predominant exercise types.
Journal ArticleDOI
The effect of dry-weight reduction guided by lung ultrasound on ambulatory blood pressure in hemodialysis patients: a randomized controlled trial
Charalampos Loutradis,Pantelis Sarafidis,Robert Ekart,Christodoulos Papadopoulos,Vasileios Sachpekidis,Maria Eleni Alexandrou,Dorothea Papadopoulou,Giorgos Efstratiadis,Aikaterini Papagianni,Gérard M. London,Carmine Zoccali +10 more
TL;DR: A lung-ultrasound-guided strategy for dry-weight reduction can effectively and safely reduce ambulatory BP levels in hemodialysis patients and clinical implementation of this simple technique can help increase BP control in this population of patients with hypertension.
Journal ArticleDOI
Lung Ultrasound–Guided Dry Weight Assessment and Echocardiographic Measures in Hypertensive Hemodialysis Patients: A Randomized Controlled Study
Charalampos Loutradis,Christodoulos Papadopoulos,Vassilios Sachpekidis,Robert Ekart,Barbara Krunic,Antonios Karpetas,Athanasios Bikos,Ioannis Tsouchnikas,Efstathios Mitsopoulos,Aikaterini Papagianni,Carmine Zoccali,Pantelis Sarafidis +11 more
TL;DR: A US-guided strategy for dry weight reduction is associated with decreased cardiac chamber dimensions and LV filling pressure, but no difference in systolic performance compared with usual care in hypertensive hemodialysis patients.
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