Hypertension in patients on chronic hemodialysis: pathophysiology and treatment

Hippokratia 2004, 8(4):147-150

G Pekovic – Perunicic
Nephrology Dpt, University Hospital Zemun – Belgrdade, Belgrade, Serbia Montenegro


The incidence of end-stage renal disease (ESRD) has been doubled over the past 10 years and the leading causes of ESRD are hypertension and diabetes. The prevalence of arterial hypertension among dialysis patients is high and approximately 80-90% of patients are hypertensive by the time chronic renal failure progresses to ESRD. Recently, the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC) have published their guidelines for the management of arterial hypertension. Chronic kidney disease (CKD) and ESRD are associated with an increased prevalence of cardiovascular (CV) disease.
The main pathophysiological mechanism of hypertension in dialysis patients is extracellular volume expansion, which is typically sodium sensitive, given the loss of renal function.
All recommendations for management of hypertension in dialysis patients focuses on the CV risk factor in dialysis patients because of hypertension. Hypertension is discussed in the new light of modern CV risk assessment.
The first goal of hypertension treatment in dialysis patients is the achievement of dry body weight and dietary sodium and water restriction. The second goal is pharmacological treatment of hypertension, if it still exists, after the achievement of the first goal.