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Management of intradialytic hypertension: the ongoing challenge

There is no widely accepted definition of intradialytic hypertension. Arbitrary clinical definitions have included an increase in blood pressure during or immediately after hemodialysis, a rise in blood pressure during the second or third hour of dialysis, and an increase in blood pressure that is r...

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Published in:	Seminars in dialysis 2006-03, Vol.19 (2), p.141-145
Main Authors:	Chen, Joline, Gul, Ambreen, Sarnak, Mark J
Format:	Article
Language:	English
Subjects:	Arginine - analogs & derivatives Arginine - physiology Blood Volume - physiology Calcium - blood Cardiac Output - physiology Endothelin-1 - physiology Erythropoietin - adverse effects Humans Hypertension - epidemiology Hypertension - etiology Hypertension - physiopathology Hypertension - therapy Nitric Oxide - physiology Potassium - blood Recombinant Proteins Renal Dialysis - adverse effects Renal Dialysis - methods Renin-Angiotensin System - physiology Sodium - blood Sympathetic Nervous System - physiopathology
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container_title	Seminars in dialysis
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creator	Chen, Joline Gul, Ambreen Sarnak, Mark J
description	There is no widely accepted definition of intradialytic hypertension. Arbitrary clinical definitions have included an increase in blood pressure during or immediately after hemodialysis, a rise in blood pressure during the second or third hour of dialysis, and an increase in blood pressure that is resistant to ultrafiltration. To date, no studies have evaluated the prevalence and prognostic importance of intradialytic hypertension. The pathogenesis of intradialytic hypertension is complex and is due in part to extracellular fluid volume expansion, increased cardiac output, activation of the renin-angiotensin system and the sympathetic nervous system, increased circulating vasoactive substances resulting in peripheral vasoconstriction, erythropoietin use, and fluctuations in electrolytes and removal of antihypertensive medications during the dialysis procedure. Management strategies of intradialytic hypertension are based on expert opinion using the pathophysiologic principles described above. We conclude that additional epidemiologic, basic science, and interventional studies are needed to further elucidate the prevalence, prognostic importance, pathophysiology, and potential treatment of intradialytic hypertension.
doi_str_mv	10.1111/j.1525-139X.2006.00140.x
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Arbitrary clinical definitions have included an increase in blood pressure during or immediately after hemodialysis, a rise in blood pressure during the second or third hour of dialysis, and an increase in blood pressure that is resistant to ultrafiltration. To date, no studies have evaluated the prevalence and prognostic importance of intradialytic hypertension. The pathogenesis of intradialytic hypertension is complex and is due in part to extracellular fluid volume expansion, increased cardiac output, activation of the renin-angiotensin system and the sympathetic nervous system, increased circulating vasoactive substances resulting in peripheral vasoconstriction, erythropoietin use, and fluctuations in electrolytes and removal of antihypertensive medications during the dialysis procedure. Management strategies of intradialytic hypertension are based on expert opinion using the pathophysiologic principles described above. 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subjects	Arginine - analogs & derivatives Arginine - physiology Blood Volume - physiology Calcium - blood Cardiac Output - physiology Endothelin-1 - physiology Erythropoietin - adverse effects Humans Hypertension - epidemiology Hypertension - etiology Hypertension - physiopathology Hypertension - therapy Nitric Oxide - physiology Potassium - blood Recombinant Proteins Renal Dialysis - adverse effects Renal Dialysis - methods Renin-Angiotensin System - physiology Sodium - blood Sympathetic Nervous System - physiopathology
title	Management of intradialytic hypertension: the ongoing challenge
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