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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)

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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.
Keywords
AMBULATORY BLOOD-PRESSURE, LEFT-VENTRICULAR HYPERTROPHY, RANDOMIZED, CONTROLLED-TRIAL, RECOMBINANT-HUMAN-ERYTHROPOIETIN, INTERDIALYTIC, WEIGHT-GAIN, CHRONIC-HEMODIALYSIS PATIENTS, OBSTRUCTIVE SLEEP-APNEA, IN-CENTER HEMODIALYSIS, PATIENTS RECEIVING HEMODIALYSIS, HIGH-DOSE, FUROSEMIDE, blood pressure, end-stage renal disease, haemodialysis, hypertension, peritoneal dialysis

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Chicago
Sarafidis, Pantelis A, Alexandre Persu, Rajiv Agarwal, Michel Burnier, Peter de Leeuw, Charles J Ferro, Jean-Michel Halimi, et al. 2017. “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).” Nephrology Dialysis Transplantation 32 (4): 620–640.
APA
Sarafidis, P. A., Persu, A., Agarwal, R., Burnier, M., de Leeuw, P., Ferro, C. J., Halimi, J.-M., et al. (2017). 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). NEPHROLOGY DIALYSIS TRANSPLANTATION, 32(4), 620–640.
Vancouver
1.
Sarafidis PA, Persu A, Agarwal R, Burnier M, de Leeuw P, Ferro CJ, et al. 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). NEPHROLOGY DIALYSIS TRANSPLANTATION. 2017;32(4):620–40.
MLA
Sarafidis, Pantelis A, Alexandre Persu, Rajiv Agarwal, et al. “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).” NEPHROLOGY DIALYSIS TRANSPLANTATION 32.4 (2017): 620–640. Print.
@article{8529582,
  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.},
  author       = {Sarafidis, Pantelis A and Persu, Alexandre and Agarwal, Rajiv and Burnier, Michel and de Leeuw, Peter and Ferro, Charles J and Halimi, Jean-Michel and Heine, Gunnar H and Jadoul, Michel and Jarraya, Faical and Kanbay, Mehmet and Mallamaci, Francesca and Mark, Patrick B and Ortiz, Alberto and Parati, Gianfranco and Pontremoli, Roberto and Rossignol, Patrick and Ruilope, Luis and Van der Niepen, Patricia and Vanholder, Raymond and Verhaar, Marianne C and Wiecek, Andrzej and Wuerzner, Gregoire and London, G{\'e}rard M and Zoccali, Carmine},
  issn         = {0931-0509},
  journal      = {NEPHROLOGY DIALYSIS TRANSPLANTATION},
  keyword      = {AMBULATORY BLOOD-PRESSURE,LEFT-VENTRICULAR HYPERTROPHY,RANDOMIZED,CONTROLLED-TRIAL,RECOMBINANT-HUMAN-ERYTHROPOIETIN,INTERDIALYTIC,WEIGHT-GAIN,CHRONIC-HEMODIALYSIS PATIENTS,OBSTRUCTIVE SLEEP-APNEA,IN-CENTER HEMODIALYSIS,PATIENTS RECEIVING HEMODIALYSIS,HIGH-DOSE,FUROSEMIDE,blood pressure,end-stage renal disease,haemodialysis,hypertension,peritoneal dialysis},
  language     = {eng},
  number       = {4},
  pages        = {620--640},
  title        = {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)},
  url          = {http://dx.doi.org/10.1093/ndt/gfw433},
  volume       = {32},
  year         = {2017},
}

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