| Theme |
Blood Pressure Control of Chronic Kidney Disease during Conservative Treatment, on Dialysis, and after Kidney Transplantation |
| Title |
Therapy for hypertension and arteriosclerosis in hemodialysis patients |
| Author |
Kosaku Nitta |
Department of Medicine, Kidney Center, Tokyo Women's Medical University |
| [ Summary ] |
Hypertension is an important risk factor for cardiovascular mortality in hemodialysis patients. According to recent literature, blood pressure should be controlled between 160 / 90 mmHg for pre-dialysis and 120 / 75 for post-dialysis stages. Calcium channel blockers and angiotensin converting enzyme inhibitors or angiotensin receptor blockers have been used as first choice anti-hypertensive agents, while evidence of their efficacy has not been established. On the other hand, arteriosclerosis is an important risk factor for cardiovascular mortality in these patients. The pathogenesis of arteriosclerosis is thought to be a combination of atherosclerosis and vascular calcification. Antioxidant therapy and treatment for dyslipideima are effective in preventing atherosclerosis. In addition, control of serum levels of calcium and phosphorus is a fundamental approach to reduce the progression of vascular calcification. Recently, sevelamer has been introduced as a phosphate binder which dose not contain calcium and has been shown to reduce vascular calcification. Bisphosphonate may be effective to prevent the progression of vascular calcification. |