Hypertension in dialysis.

PURPOSE OF REVIEW: Hypertension is highly prevalent in dialysis patients and may be important to the high cardiovascular mortality of this population. This review shows the current direction in dialysis-associated hypertension management.

RECENT FINDINGS: Decreasing dialysate sodium concentration based on pre-hemodialysis plasma sodium concentration may have an additive effect in controlling hypertension. Sympathetic nervous system overactivity is an important feature of end-stage renal disease; a new amine oxidase, renalase, may be relevant to the pathogenesis of hypertension in this population. Similarly, drugs that block the sympathetic nervous system are uniformly protective in dialysis patients. Daily dialysis (short or long) results in better blood pressure control, and the mechanisms resulting in this effect are increasingly better understood.

SUMMARY: Long-term control of hypertension is necessary in dialysis patients. The better understanding of the dialysis-associated hypertension pathogenesis has impact on the dialysis prescription and antihypertensive drug choices.