scholarly journals Improvement of Resistant Hypertension by Nocturnal Hemodialysis in a Patient with End-Stage Kidney Disease

2015 ◽  
Vol 5 (1) ◽  
pp. 60-65
Author(s):  
Xiaojing Tang ◽  
Xiaohong Hu ◽  
Changlin Mei ◽  
Shengqiang Yu
Keyword(s):  
Blood Pressure ◽  
Kidney Disease ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Blood Flow Rate ◽  
Plasma Renin ◽  
End Stage Kidney Disease ◽  
Blood Biochemical ◽  
Cardiovascular Morbidity And Mortality ◽  
End Stage

Resistant hypertension is a common and refractory complication of hemodialysis (HD) patients and is associated with a higher risk of cardiovascular morbidity and mortality. Here we present a case of resistant hypertension treated successfully by nocturnal HD. A 63-year-old female with end-stage kidney disease was hospitalized for severe headache, objective vertigo and persistent vomiting for 1 month on February 6, 2012. She had been on intermittent HD for 3 months, and her blood pressure maintained 200-240/100-130 mm Hg even after using 7 kinds of antihypertensive drugs including olmesartan, benazepril, nitrendipine, arotinolol, terazosin, clonidine and torasemide. A CT of the abdomen revealed a mild hyperplasia of the left adrenal gland (fig. 1). However, plasma renin, angiotensin and aldosterone were all within the normal range. Nocturnal extended HD was initiated with a blood flow rate of 150 ml/min and a dialysis time of 7 h. After 3 months of nocturnal HD, all symptoms were relieved and her systolic blood pressure started to decrease by 10-20 mm Hg. Six months later, the predialysis blood pressure was decreased to 140-160/90-100 mm Hg and the antihypertensive drugs were reduced to 4 kinds. Meanwhile, the blood biochemical parameters including hemoglobin, serum calcium, phosphate and parathyroid hormone were all controlled well during 2 years of treatment. This case indicates that nocturnal extended HD is probably a promising and effective choice for resistant hypertension in HD patients.

Age dependence of brachial cuff-based ambulatory PWV in end-stage kidney disease patients undergoing long-term peritoneal dialysis

2021 ◽  
pp. 089686082199692
Author(s):  
Vasilios Vaios ◽  
Panagiotis I Georgianos ◽  
Georgia Vareta ◽  
Dimitrios Divanis ◽  
Evangelia Dounousi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Heart Rate ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Pulse Wave ◽  
Age Dependence ◽  
End Stage Kidney Disease ◽  
End Stage

Background: The newly introduced device Mobil-O-Graph (IEM, Stolberg, Germany) combines brachial cuff oscillometry and pulse wave analysis, enabling the determination of pulse wave velocity (PWV) via complex mathematic algorithms during 24-h ambulatory blood pressure monitoring (ABPM). However, the determinants of oscillometric PWV in the end-stage kidney disease (ESKD) population remain poorly understood. Methods: In this study, 81 ESKD patients undergoing long-term peritoneal dialysis underwent 24-h ABPM with the Mobil-O-Graph device. The association of 24-h oscillometric PWV with several demographic, clinical and haemodynamic parameters was explored using linear regression analysis. Results: In univariate analysis, among 21 risk factors, 24-h PWV exhibited a positive relationship with age, body mass index, overhydration assessed via bioimpedance spectroscopy, diabetic status, history of dyslipidaemia and coronary heart disease, and it had a negative relationship with female sex and 24-h heart rate. In stepwise multivariate analysis, age ( β: 0.883), 24-h systolic blood pressure (BP) ( β: 0.217) and 24-h heart rate ( β: −0.083) were the only three factors that remained as independent determinants of 24-h PWV (adjusted R 2 = 0.929). These associations were not modified when all 21 risk factors were analysed conjointly or when the model included only variables shown to be significant in univariate comparisons. Conclusion: The present study shows that age together with simultaneously assessed oscillometric BP and heart rate are the major determinants of Mobil-O-Graph-derived PWV, explaining >90% of the total variation of this marker. This age dependence of oscillometric PWV limits the validity of this marker to detect the premature vascular ageing, a unique characteristic of vascular remodelling in ESKD.

scholarly journals Effect of Arteriovenous Fistula Creation on Systolic and Diastolic Blood Pressure in Patients With Pre-dialysis Advanced Chronic Kidney Disease

2019 ◽  
Vol 32 (9) ◽  
pp. 858-867 ◽  
Author(s):  
Roy O Mathew ◽  
Jerome Fleg ◽  
Janani Rangaswami ◽  
Bo Cai ◽  
Arif Asif ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Kidney Disease ◽  
Arteriovenous Fistula ◽  
Resistant Hypertension ◽  
Repeated Measures ◽  
Treatment Resistant ◽  
Advanced Chronic Kidney Disease ◽  
Stage Renal Disease ◽  
End Stage

AbstractBACKGROUNDCentral arteriovenous fistula (cAVF) has been investigated as a therapeutic measure for treatment-resistant hypertension in patients without advanced chronic kidney disease (CKD). There is considerable experience with the use of AVF for hemodialysis in patients with end-stage renal disease (ESRD). However, there is sparse data on the blood pressure (BP) effects of an AVF among patients with ESRD. We hypothesized that AVF creation would significantly reduce BP compared with patients who did not have an AVF among patients with ESRD before starting hemodialysis.METHODSBPs were compared during the 12 months before hemodialysis initiation in 399 patients with an AVF or AV graft created and 4,696 patients without either.RESULTSAfter propensity score matching 1:2 ratio (AVF to no AVF), repeated measures analysis of variance revealed significant reductions of –1.7 mm Hg systolic and –3.9 mm Hg diastolic BP 12 months in patients after AVF creation; P = 0.025 and P < 0.001, respectively, compared with those with no AVF.CONCLUSIONSThese findings suggest that AVF creation results in modest BP reduction in patients with pre-dialysis ESRD who require AVF for eventual hemodialysis therapy. Preferential diastolic BP reduction suggests that greater work is needed to characterize the ideal patient subset in which to use cAVF for treatment-resistant hypertension in those without advanced CKD.

scholarly journals Cerebral blood flow regulation in end-stage kidney disease

2020 ◽  
Vol 319 (5) ◽  
pp. F782-F791
Author(s):  
Justin D. Sprick ◽  
Joe R. Nocera ◽  
Ihab Hajjar ◽  
W. Charles O’Neill ◽  
James Bailey ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Kidney Disease ◽  
Cerebral Oxygenation ◽  
Cerebrovascular Reactivity ◽  
Regulatory Mechanisms ◽  
End Stage Kidney Disease ◽  
Increased Risk ◽  
End Stage

Patients with chronic kidney disease (CKD) and end-stage kidney disease (ESKD) experience an increased risk of cerebrovascular disease and cognitive dysfunction. Hemodialysis (HD), a major modality of renal replacement therapy in ESKD, can cause rapid changes in blood pressure, osmolality, and acid-base balance that collectively present a unique stress to the cerebral vasculature. This review presents an update regarding cerebral blood flow (CBF) regulation in CKD and ESKD and how the maintenance of cerebral oxygenation may be compromised during HD. Patients with ESKD exhibit decreased cerebral oxygen delivery due to anemia, despite cerebral hyperperfusion at rest. Cerebral oxygenation further declines during HD due to reductions in CBF, and this may induce cerebral ischemia or “stunning.” Intradialytic reductions in CBF are driven by decreases in cerebral perfusion pressure that may be partially opposed by bicarbonate shifts during dialysis. Intradialytic reductions in CBF have been related to several variables that are routinely measured in clinical practice including ultrafiltration rate and blood pressure. However, the role of compensatory cerebrovascular regulatory mechanisms during HD remains relatively unexplored. In particular, cerebral autoregulation can oppose reductions in CBF driven by reductions in systemic blood pressure, while cerebrovascular reactivity to CO2 may attenuate intradialytic reductions in CBF through promoting cerebral vasodilation. However, whether these mechanisms are effective in ESKD and during HD remain relatively unexplored. Important areas for future work include investigating potential alterations in cerebrovascular regulation in CKD and ESKD and how key regulatory mechanisms are engaged and integrated during HD to modulate intradialytic declines in CBF.

Increased Inflammatory Response in Association with the Initiation of Hemodialysis Compared with Peritoneal Dialysis in a Prospective Study of End-Stage Kidney Disease Patients

2018 ◽  
Vol 38 (1) ◽  
pp. 18-23 ◽  
Author(s):  
Kenneth Yong ◽  
Gursharan Dogra ◽  
Neil Boudville ◽  
Wai Lim
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Kidney Disease ◽  
Inflammatory Response ◽  
Prospective Study ◽  
End Stage Kidney Disease ◽  
Cvd Risk ◽  
Ckd Stage ◽  
End Stage

Background Large epidemiological studies have demonstrated an early survival advantage with the initiation of peritoneal dialysis (PD) compared to haemodialysis (HD). Chronic inflammation may contribute to atherosclerosis and cardiovascular (CVD) mortality in end-stage kidney disease (ESKD). We hypothesize that the initiation of HD in ESKD patients is associated with a greater inflammatory response compared with PD. Aims To examine the effects of initiating HD and PD upon inflammation and CVD risk markers in ESKD patients. Methods We per formed a pilot prospective study on 75 predialysis CKD stage-5 subjects comparing the effects of HD and PD upon high sensitivity C-reactive protein (hsCRP), interleukin(IL)-12, IL-18 and pulse wave velocity (PWV). Study visits were conducted 3 – 6 months before (baseline) and after (follow-up) initiation of dialysis Results Thirty-nine and 36 patients were initiated on HD and PD respectively. HD patients were older than PD patients (65.1 ± 2.1 vs 57.7 ± 2.7 years; p = 0.03) but had similar baseline systolic blood pressure (SBP), pulse pressure (PP), hsCRP, IL-12, IL-18, and PWV. At follow-up, HD patients had significantly increased hsCRP levels [5.2(3.7, 7.3) vs 1.7(1.0, 2.8)g/L; p < 0.001] compared to PD. Follow-up blood pressure, IL-12, IL-18, and PWV were similar between groups. A significant association remained between hsCRP and HD after adjustment for age, previous CVD, and residual urine output. Conclusion The initiation of HD was associated with significantly increased hsCRP compared to PD. Further study is required to determine the plausibility of inflammation as a potential underlying contributor to the observed early mortality difference between dialysis modalities.

scholarly journals Mild sodium reduction in peritoneal dialysis solution improves hypertension in end stage kidney disease: a case-report study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Luigi Vecchi ◽  
Mario Bonomini ◽  
Roberto Palumbo ◽  
Arduino Arduini ◽  
Silvio Borrelli
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Case Report ◽  
Kidney Disease ◽  
Substantial Reduction ◽  
End Stage Kidney Disease ◽  
Low Sodium ◽  
First Case ◽  
End Stage ◽  
Residual Diuresis

Abstract Introduction Blood Pressure (BP) control is largely unsatisfied in End Stage Kidney Disease (ESKD) principally due to sodium retention. Peritoneal Dialysis (PD) is the most common type of home dialysis, using a peritoneal membrane to remove sodium, though sodium removal remains challenging. Methods This is a case-study reporting two consecutive ESKD patients treated by a novel peritoneal PD solution with a mildly reduced sodium content (130 mmol/L) to treat hypertension. Results In the first case, a 78-year-old woman treated by Continuous Ambulatory PD (CAPD) with standard solution (three 4 h-dwells per day 1.36% glucose 132 mmol/L) showed resistant hypertension confirmed by ambulatory blood pressure monitoring (ABPM), reporting 24 h-BP: 152/81 mmHg, day-BP:151/83 mmHg and night-ABP: 153/75 mmHg, with inversion of the circadian systolic BP rhythm (1.01), despite use of three anti-hypertensives and a diuretic at adequate doses. No sign of hypervolemia was evident. We then switched from standard PD to low-sodium solution in all daily dwells. A six-months low-sodium CAPD enabled us to reduce diurnal (134/75 mmHg) and nocturnal BP (122/67 mmHg), restoring the circadian BP rhythm, with no change in ultrafiltration or residual diuresis. Diet and drug prescription were unmodified too. The second case was a 61-year-old woman in standard CAPD (three 5 h-dwells per day) suffering from hypertension confirmed by ABPM (mean 24 h-ABP: 139/84 mmHg; mean day-ABP:144/88 mmHg and mean night-ABP:124/70 mmHg). She was switched from 132-Na CAPD to 130-Na CAPD, not changing dialysis schedule. No fluid expansion was evident. During low-sodium CAPD, antihypertensive therapy (amlodipine 10 mg and Olmesartan 20 mg) has been reduced until complete suspension. After 6 months, we repeated ABPM showing a substantial reduction in mean 24 h-ABP (117/69 mmHg), mean diurnal ABP (119/75 mmHg) and mean nocturnal ABP (111/70 mmHg). Ultrafiltration and residual diuresis remained unmodified. No side effects were reported in either cases. Conclusions This case-report study suggests that mild low-sodium CAPD might reduce BP in hypertensive ESKD patients.

ENDOVASCULAR RENAL DENERVATION EFFICACY AND FEASIBILITY IN END-STAGE KIDNEY DISEASE WITH RESISTANT HYPERTENSION

2018 ◽  
Vol 36 (Supplement 1) ◽  
pp. e54-e55
Author(s):  
A. Mazza ◽  
F. Dell’Avvocata ◽  
F. Fiorini ◽  
F. Michielan ◽  
A.F. Compostella ◽  
...  
Keyword(s):  
Kidney Disease ◽  
Resistant Hypertension ◽  
Renal Denervation ◽  
End Stage Kidney Disease ◽  
End Stage

RESISTANT ARTERIAL HYPERTENSION IN PATIENTS WITH CHRONIC KIDNEY DISEASE: PREVALENCE, PROGNOSTIC SIGNIFICANCE, REASONS AND APPROACHES TO ANTIHYPERTENSIVE THERAPY

2019 ◽  
Vol 23 (1) ◽  
pp. 37-44 ◽  
Author(s):  
O. B. Kuzmin ◽  
V. V. Zhezha ◽  
L. N. Landar ◽  
O. A. Salova
Keyword(s):  
Blood Pressure ◽  
Chronic Kidney Disease ◽  
Drug Therapy ◽  
Kidney Disease ◽  
Arterial Hypertension ◽  
Antihypertensive Therapy ◽  
Resistant Hypertension ◽  
Antihypertensive Drugs ◽  
Refractory Hypertension ◽  
Hypertensive Patients

Arterial hypertension (AH) resistant to drug therapy is the phenotype of uncontrolled AH, in which patients receiving at least 3 antihypertensive drugs, including a diuretic, maintain blood pressure above the target level. Initially, the term refractory hypertension was also used to refer to resistant hypertension. Recently, however, refractory hypertension has been isolated into a separate phenotype of difficult to treat hypertension, which is defined as insufficient control of target blood pressure, despite the use of at least 5 different mechanisms of antihypertensive drugs, including long-acting diuretic and antagonist of mineralcorticoid receptors. Resistant hypertension is detected in 10–15 % of all hypertensive patients receiving drug therapy, and is often found in patients with chronic kidney disease. Hypertension can be a cause and/or consequence of kidney damage and is typical of most patients with chronic kidney disease. The lack of control of target blood pressure in a significant proportion of hypertensive patients with CKD who receive at least 3 antihypertensive drugs of different mechanisms of action indicates a lack of effectiveness of antihypertensive therapy, which not only accelerates the loss of renal function, but also significantly worsens the prognosis, contributing to such people risk of cardiovascular and renal complications. The review presents data on the prevalence, prognostic value of resistant hypertension in patients with chronic kidney disease, features of its formation and approaches to increasing the effectiveness of antihypertensive therapy in this patient population.

scholarly journals Plasma Renin Activity in End-Stage Kidney Disease

Circulation ◽  
1969 ◽  
Vol 40 (4) ◽  
pp. 563-574 ◽  
Author(s):  
MICHAEL GUTKIN ◽  
GILBERT E. LEVINSON ◽  
ANTHONY S. KING ◽  
NORMAN LASKER
Keyword(s):  
Kidney Disease ◽  
Plasma Renin Activity ◽  
Plasma Renin ◽  
Renin Activity ◽  
End Stage Kidney Disease ◽  
End Stage
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