Management of hypertension in chronic kidney disease

Abstract

Hypertension is a common comorbidity in patients with impaired kidney function. The kidney exerts a marked degree of control over blood pressure through various mechanisms, such as by regulating sodium balance and hormone secretion through the activity of the renin-angiotensin system. The kidney is susceptible to injury, and if already damaged can be at risk of further loss of function as a consequence of elevated blood pressure. Once elevated blood pressure is identified, a combination of sensible lifestyle measures, such as sodium restriction and weight loss, with pharmacological intervention to reduce blood pressure will usually achieve blood pressure goals. In this Review, we outline the importance of blood pressure control for patients with chronic kidney disease (CKD), the mechanisms that affect blood pressure control, and the basis for non-drug and drug therapies. We further discuss the rationale for <140 mmHg systolic and <90 mmHg diastolic targets for blood pressure in patients with CKD, with consideration for tighter targets in the setting of proteinuria.

Relationship between the exposure to cumulative cardiovascular health behaviors and factors and chronic kidney disease—The Kailuan study

“…CKD was defined as eGFR <60 ml/min/1.73 m 2 and/or positive proteinuria [9–12]. For those who had abnormal physical examination results, we suggested them to visit the relevant clinic of our hospital and affiliated hospitals to confirm the diagnosis and receive the appropriate treatments.…”

Fibroblast Growth Factor 23 Predicts All-Cause Mortality in a Dose-Response Fashion in Pre-Dialysis Patients with Chronic Kidney Disease

“…Because of the close connection between the circulation and urinary system in the water-electrolyte metabolism, the glomerular filtration rate (GFR) associated with the prevalence of cardiovascular diseases (CVDs) in the CKD population declined directly [3,4] . Anaemia, metabolic bone disease, and acidosis are also common complications of CKD [5][6][7] .…”

The cytoskeleton as a novel target for treatment of renal fibrosis

“…However, growth factor signaling, including hepatocyte growth factor, connective tissue growth factor (CTGF) and vascular endothelial growth factor (Nguyen and Golschmeding, 2008;Liu and Yang, 2006;Kang and Johnson, 2003), angiotensin II (Macconi et al, 2014), inflammation (Cao et al, 2015), hypoxia (Kawakami et al, 2014), and the wnt pathway (Tan et al, 2014) are linked to the initiation and progression of renal fibrosis. Despite much research defining these molecular and cellular pathways, translation of these findings to the clinical has yet to impact management of CKD, which still primarily relies on slowing disease progression through managing hypertension and/or diabetes, and minimizing cardiovascular comorbidities (Vassalotti et al, 2016;Roche-Recinos et al, 2015;Townsend and Taler, 2015;Wouters et al, 2015).…”