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 A. Sarafidis, Alexandre Persu, Rajiv Agarwal, Michel Burnier, Peter 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 Ruilope, Patricia Van Der Niepen, Raymond VanholderMarianne C. Verhaar, Andrzej Wiecek, Gregoire Wuerzner, Gérard M. London, Carmine Zoccali

Research output: Contribution to journalReview article

34 Citations (Scopus)

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 mechanismof 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. Nonpharmacologic 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.

Original languageEnglish
Pages (from-to)620-640
Number of pages21
JournalNephrology Dialysis Transplantation
Volume32
Issue number4
DOIs
Publication statusPublished - Apr 1 2017

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Dialysis
Medicine
Hypertension
Transplants
Kidney
Ambulatory Blood Pressure Monitoring
Sodium
Blood Pressure
Renal Dialysis
Vascular Stiffness
Survival
Sympathetic Nervous System
Sleep Apnea Syndromes
Angiotensins
Expert Testimony
Peritoneal Dialysis
Therapeutics
Erythropoietin
Aldosterone
Renin

Keywords

  • blood pressure
  • end-stage renal disease
  • haemodialysis
  • hypertension
  • peritoneal dialysis

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

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)∗. / Sarafidis, Pantelis A.; Persu, Alexandre; Agarwal, Rajiv; Burnier, Michel; De Leeuw, Peter; Ferro, Charles J.; Halimi, Jean Michel; Heine, Gunnar H.; Jadoul, Michel; Jarraya, Faical; Kanbay, Mehmet; Mallamaci, Francesca; Mark, Patrick B.; Ortiz, Alberto; Parati, Gianfranco; Pontremoli, Roberto; Rossignol, Patrick; Ruilope, Luis; Van Der Niepen, Patricia; Vanholder, Raymond; Verhaar, Marianne C.; Wiecek, Andrzej; Wuerzner, Gregoire; London, Gérard M.; Zoccali, Carmine.

In: Nephrology Dialysis Transplantation, Vol. 32, No. 4, 01.04.2017, p. 620-640.

Research output: Contribution to journalReview article

Sarafidis, PA, Persu, A, Agarwal, R, Burnier, M, De Leeuw, P, Ferro, CJ, Halimi, JM, Heine, GH, Jadoul, M, Jarraya, F, Kanbay, M, Mallamaci, F, Mark, PB, Ortiz, A, Parati, G, Pontremoli, R, Rossignol, P, Ruilope, L, Van Der Niepen, P, Vanholder, R, Verhaar, MC, Wiecek, A, Wuerzner, G, London, GM & Zoccali, C 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, vol. 32, no. 4, pp. 620-640. https://doi.org/10.1093/ndt/gfw433
Sarafidis, Pantelis A. ; Persu, Alexandre ; Agarwal, Rajiv ; Burnier, Michel ; De Leeuw, Peter ; Ferro, Charles J. ; Halimi, Jean Michel ; Heine, Gunnar H. ; Jadoul, Michel ; Jarraya, Faical ; Kanbay, Mehmet ; Mallamaci, Francesca ; Mark, Patrick B. ; Ortiz, Alberto ; Parati, Gianfranco ; Pontremoli, Roberto ; Rossignol, Patrick ; Ruilope, Luis ; Van Der Niepen, Patricia ; Vanholder, Raymond ; Verhaar, Marianne C. ; Wiecek, Andrzej ; Wuerzner, Gregoire ; London, Gérard M. ; Zoccali, Carmine. / 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)∗. In: Nephrology Dialysis Transplantation. 2017 ; Vol. 32, No. 4. pp. 620-640.
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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 mechanismof 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. Nonpharmacologic 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.",
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AU - Persu, Alexandre

AU - Agarwal, Rajiv

AU - Burnier, Michel

AU - De Leeuw, Peter

AU - Ferro, Charles J.

AU - Halimi, Jean Michel

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AU - Jarraya, Faical

AU - Kanbay, Mehmet

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AU - Mark, Patrick B.

AU - Ortiz, Alberto

AU - Parati, Gianfranco

AU - Pontremoli, Roberto

AU - Rossignol, Patrick

AU - Ruilope, Luis

AU - Van Der Niepen, Patricia

AU - Vanholder, Raymond

AU - Verhaar, Marianne C.

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