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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)

(2017) JOURNAL OF HYPERTENSION. 35(4). p.657-676
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Abstract
In patients with end-stage renal disease treated with hemodialysis or peritoneal dialysis, hypertension is very common and often poorly controlled. Blood pressure (BP) recordings obtained before or after hemodialysis display a J-shaped or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar hemodynamic setting related with dialysis treatment. Elevated BP 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 apnea and the use of erythropoietin-stimulating agents may also be involved. Nonpharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium-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, PATIENTS RECEIVING, HEMODIALYSIS, INTERDIALYTIC WEIGHT-GAIN, OBSTRUCTIVE SLEEP-APNEA, IN-CENTER HEMODIALYSIS, HIGH-DOSE FUROSEMIDE, PERITONEAL-DIALYSIS, blood pressure, dry-weight, end-stage renal disease, hemodialysis, hypertension, peritoneal dialysis, sodium excess

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Citation

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Chicago
Sarafidis, Pantelis A, Alexandre Persu, Rajiv Agarwal, Michel Burnier, Peter de Leeuw, Charles 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).” Journal of Hypertension 35 (4): 657–676.
APA
Sarafidis, P. A., Persu, A., Agarwal, R., Burnier, M., de Leeuw, P., Ferro, C., 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). JOURNAL OF HYPERTENSION, 35(4), 657–676.
Vancouver
1.
Sarafidis PA, Persu A, Agarwal R, Burnier M, de Leeuw P, Ferro C, 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). JOURNAL OF HYPERTENSION. 2017;35(4):657–76.
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).” JOURNAL OF HYPERTENSION 35.4 (2017): 657–676. Print.
@article{8529842,
  abstract     = {In patients with end-stage renal disease treated with hemodialysis or peritoneal dialysis, hypertension is very common and often poorly controlled. Blood pressure (BP) recordings obtained before or after hemodialysis display a J-shaped or U-shaped association with cardiovascular events and survival, but this most likely reflects the low accuracy of these measurements and the peculiar hemodynamic setting related with dialysis treatment. Elevated BP 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 apnea and the use of erythropoietin-stimulating agents may also be involved. Nonpharmacologic interventions targeting sodium and volume excess are fundamental for hypertension control in this population. If BP remains elevated after appropriate treatment of sodium-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 and Halimi, Jean-Michel and Heine, Gunnar 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, Gerard M and Zoccali, Carmine},
  issn         = {0263-6352},
  journal      = {JOURNAL OF HYPERTENSION},
  keyword      = {AMBULATORY BLOOD-PRESSURE,LEFT-VENTRICULAR HYPERTROPHY,RANDOMIZED,CONTROLLED-TRIAL,RECOMBINANT-HUMAN-ERYTHROPOIETIN,PATIENTS RECEIVING,HEMODIALYSIS,INTERDIALYTIC WEIGHT-GAIN,OBSTRUCTIVE SLEEP-APNEA,IN-CENTER HEMODIALYSIS,HIGH-DOSE FUROSEMIDE,PERITONEAL-DIALYSIS,blood pressure,dry-weight,end-stage renal disease,hemodialysis,hypertension,peritoneal dialysis,sodium excess},
  language     = {eng},
  number       = {4},
  pages        = {657--676},
  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/10.1097/HJH.0000000000001283},
  volume       = {35},
  year         = {2017},
}

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