Importance of Volume Factors in Dialysis-Related Hypertension

Lins, R.L.; Raedt, Herbert De; Zachée, Pierre; Daelemans, R.

doi:10.1007/978-1-4615-3884-4_77

Cited by 32 publications

(40 citation statements)

References 4 publications

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“…Although predialysis BP seems to be related to total body water and not the between-dialysis weight gain [161], postdialysis BP depends on ultrafiltration. Monitoring BP at home thus carries the potential to give us information useful to select the best dialysis conditions.…”

Section: Patients With Arrhythmiasmentioning

confidence: 89%

European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring

Parati

Stergiou²,

Asmar

et al. 2008

Journal of Hypertension

761

646

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Section: Patients With Arrhythmiasmentioning

confidence: 89%

European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring

Parati

Stergiou²,

Asmar

et al. 2008

Journal of Hypertension

761

646

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“…Chronic hypervolemia leads to hypertension, structural heart disease, and pulmonary edema (1)(2)(3)(4)(5)(6), and intradialytic hypovolemia is associated with cramps, nausea, vomiting, and decreased patient satisfaction (7)(8)(9)(10)(11). Intradialytic hypotension is one of the most frequent complications of hemodialysis (HD); its incidence varies from 10 to 30% of sessions, depending on the population studied (12).…”

mentioning

confidence: 99%

Handcarried Ultrasound Measurement of the Inferior Vena Cava for Assessment of Intravascular Volume Status in the Outpatient Hemodialysis Clinic

Brennan

Ronan

Goonewardena

et al. 2006

Clinical Journal of the American Society of Nephrology

190

133

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Accurate intravascular volume assessment is critical in the treatment of patients who receive chronic hemodialysis (HD) therapy. Clinically assessed dry weight is a poor surrogate of intravascular volume; however, ultrasound assessment of the inferior vena cava (IVC) is an effective tool for volume management. This study sought to determine the feasibility of using operators with limited ultrasound experience to assess IVC dimensions using hand-carried ultrasounds (HCU) in the outpatient clinical setting. The IVC was assessed in 89 consecutive patients at two outpatient clinics before and after HD. Intradialytic IVC was recorded during episodes of hypotension, chest pain, or cramping. High-quality IVC images were obtained in 79 of 89 patients. Despite that 89% of patients presented at or above dry weight, 39% of these patients were hypovolemic by HCU. Of the 75% of patients who left HD at or below goal weight, 10% were still hypervolemic by HCU standards. Hypovolemic patients had more episodes of chest pain and cramping (33 versus 14%, P ‫؍‬ 0.06) and more episodes of hypotension (22 versus 3%, P ‫؍‬ 0.02). The clinic with a higher prevalence of predialysis hypovolemia had significantly more intradialytic adverse events (58 versus 27%; P ‫؍‬ 0.01). HCU measurement of the IVC is a feasible option for rapid assessment of intravascular volume status in an outpatient dialysis setting by operators with limited formal training in echocardiography. There is a poor relationship between dry weight goals and IVC collapsibility. Practice variation in the maintenance of volume status is correlated with significant differences in intradialysis adverse events.

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“…[31][32][33][34] However, it has been speculated that the blood pressure of hemodialysis patients is more dependent on the degree of a blood volume increase than RAAS activity. 35,36) Among the classes of antihypertensive drugs, CCB directly dilate vascular smooth muscle and the antihypertensive effect is not greatly influenced by the pathogenesis of hypertension. Hence, CCB are widely used in the treatment of hypertension in patients with ESRD.…”

Section: Discussionmentioning

confidence: 99%

Effects of Efonidipine, an L- and T-type Calcium Channel Blocker, on the Renin-Angiotensin-Aldosterone System in Chronic Hemodialysis Patients

et al. 2010

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SummaryComponents of the renin-angiotensin-aldosterone system such as angiotensin II and aldosterone are believed to contribute to the development and progression of cardiovascular tissue and organ injuries. We compared the effects of two calcium channel blockers, efonidipine and amlodipine, on the renin-angiotensin-aldosterone system in patients with end-stage renal diseases on maintenance hemodialysis. Twenty hypertensive patients on chronic hemodialysis were given efonidipine 20-60 mg twice daily and amlodipine 2.5-7.5 mg once daily for 12 weeks each in a random crossover manner. The average blood pressure was comparable between the efonidipine and amlodipine periods (151 ± 15/77 ± 8 versus 153 ± 15/76 ± 8 mmHg). The pulse rate did not change significantly during the administration periods. Although the plasma renin activity and plasma angiotensin II were not significantly different between the efonidipine and amlodipine periods, plasma aldosterone was significantly lower in the efonidipine period than in the amlodipine period (123 ± 118 versus 146 ± 150 pg/mL, P = 0.027). The findings suggest that efonidipine reduces plasma aldosterone levels in patients on maintenance hemodialysis, and this seems to be an additional benefit to the cardiovascular protection by antihypertensive therapy with efonidipine in patients with end-stage renal disease. (Int Heart J 2010; 51: 188-192) Key words: Efonidipine, Hypertension, Renal failure, Hemodialysis, Aldosterone P atients with end-stage renal disease (ESRD) undergoing dialysis therapy have increased morbidity and mortality as compared with the general population. The high incidences of cardiovascular diseases and infection in particular limit the life expectancy of dialysis patients.1,2) In order to effectively prevent cardiovascular diseases in ESRD patients, not only traditional cardiovascular risk factors such as hypertension, diabetes, and dyslipidemia, but also nontraditional risk factors should be considered.3) Such nontraditional risk factors include neurohumoral factors such as activation of the sympathetic nervous system and renin-angiotensin-aldosterone system (RAAS). Recent studies have shown that angiotensin II and aldosterone exhibit deleterious effects on the development and progression of tissue injuries in cardiovascular organs. [4][5][6] In addition, it has been shown that the circulating RAAS is not necessarily suppressed in patients on chronic hemodialysis. 7)Renal failure patients have a high prevalence of hypertension, 8-10) a major traditional cardiovascular risk factor, and calcium channel blockers (CCB) are widely used as antihypertensive drugs because of their potent hypotensive effects. CCB principally block L-type calcium channels of vascular smooth muscle, and have not been thought to directly affect RAAS. However, unlike other dihydropyridine CCB, efonidipine is known to block not only L-type but also T-type calcium channels, and recent in vitro and in vivo studies have indicated that efonidipine suppresses aldosterone secretion from the...

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Importance of Volume Factors in Dialysis-Related Hypertension

Cited by 32 publications

References 4 publications

European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring

European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring

Handcarried Ultrasound Measurement of the Inferior Vena Cava for Assessment of Intravascular Volume Status in the Outpatient Hemodialysis Clinic

Effects of Efonidipine, an L- and T-type Calcium Channel Blocker, on the Renin-Angiotensin-Aldosterone System in Chronic Hemodialysis Patients

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