ABSTRACT
The relevance of hypertension (HTN) in the care of patients with chronic kidney disease is undisputable. Hypertension is recognized as a major risk factor for the progression of chronic kidney disease,1 and 27% of prevalent dialysis patients in the United States have hypertension
listed as the etiology of end-stage renal disease (ESRD).2 Once on dialysis, 60-70% of patients remain hypertensive according to commonly used standards (Figure 16.1), and it is sobering to realize that as many as 11% of patients have blood pressure (BP) levels above 180/ 110 mmHg despite their frequent access to
Introduction • Mechanisms of hypertension in end-stage renal disease (ESRD) • Assessment of blood pressure in dialysis patients • Management of hypertension in end-stage renal disease (ESRD) • Conclusions • References
normotensive JNC VI stage I
JNC VI stage II JNC VI stage III
All hypertensive = 63%
Pa tie
nt s
(% )
27% 25%
Fig. 16.1 Prevalence of hypertension according to degree of blood pressure (BP) control in a large, representative cohort of dialysis patients (hemodialysis and peritoneal dialysis combined). BP was measured pre-dialysis in hemodialysis patients, and on a routine visit in peritoneal dialysis patients. JNC VI stages: I 140-159/90-99 mmHg; II 160-179/100-109 mmHg; III ≥ 180/100 mmHg. Based on data from Rahman et al, Am J Kidney Dis 20003 with permission from WB Saunders.
