Keywords
Chronic kidney disease
Dialysis
Resistant hypertension
Proteinuria
Albuminuria
Enzyme-Converting inhibitors
How to Cite
Abstract
Background: Arterial hypertension (HTN) in patients with chronic kidney disease (CKD) has some particularities that make it different from the hypertensive disorder of the general population. The differences are evident from the epidemiological data, through to the pathogenetic alterations, the blood pressure goals and the pharmacological approaches.
Purpose: With this narrative review we seek to make a detailed description of the nuances that make HTN in patients with CKD special.
Methodology: A non-systematic search was carried out in the PubMed database including clinical trials, review articles and meta-analysis in relation to HTN in patients with CKD from early stages to dialysis.
Results: 40 bibliographic references were included. The frequency of HTN in patients with CKD on dialysis is up to 3 times more prevalent when compared to the general population. The causal mechanisms of HTN in patients with CKD are multiple and complex. It includes sympathetic hyperactivity, activation of the renin-angiotensin-aldosterone system, sodium and water retention, vascular alterations and endothelial dysfunction. While resistant hypertension (RH) occurs in 13% of the general population, it occurs in up to 40% of patients with CKD. CKD produces changes in the pharmacokinetics and pharmacodynamics of antihypertensives that must be known for adequate management of hypertension in chronic kidney patients.
Conclusions: Adequate control of blood pressure levels is a cornerstone of nephroprotection management. Hypertension in chronic kidney patients has particular characteristics that must be known to achieve adequate control.
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