0000000000564216
AUTHOR
Alfred K. Cheung
Blood pressure in chronic kidney disease stage 5D—report from a Kidney Disease: Improving Global Outcomes controversies conference
Management of blood pressure (BP) in patients with chronic kidney disease receiving dialysis (stage 5D) provides a significant challenge for healthcare professionals. The association between BP and cardiovascular disease risk has been well studied in the general population; however, in dialysis patients, physiological and dialysis-related mechanisms influencing BP are complex, and the associated risk is poorly understood. In stage 5D, BP is determined by the complex interplay of fluid volume and prescription of post-dialysis target weight, sodium load, the renin–angiotensin and sympathetic nervous systems, and diverse exogenous factors, such as administration of erythropoiesis-stimulating a…
Special Considerations for Antihypertensive Agents in Dialysis Patients
Hypertension is present in most patients with end-stage renal disease and likely contributes to the premature cardiovascular disease in dialysis patients. Previous practice guidelines have recommended that, in patients on chronic dialysis, blood pressure (BP) should be reduced below 130/80 mm Hg. This is based on opinions but not strong evidence, since no concrete information exists about which BP values should be the parameter to follow and which should be the target BP values. The majority of the antihypertensive agents can be used in this population, but the pharmacokinetics altered by the impaired kidney function and dialyzability influence the appropriate dosage as well as the time and…