| Theme |
Buildup of the Guidelines for Cardiovascular Complications of Chronic Dialysis Patients |
| Title |
Hypertension and hypotension in hemodialysis patients |
| Author |
Naoki Nakagawa |
Division of Cardiology, Nephrology, Pulmonology, and Neurology, Internal Medicine, Asahikawa Medical College |
| Author |
Takayuki Fujino |
Division of Cardiology, Nephrology, Pulmonology, and Neurology, Internal Medicine, Asahikawa Medical College |
| Author |
Motoki Matsuki |
Division of Cardiology, Nephrology, Pulmonology, and Neurology, Internal Medicine, Asahikawa Medical College |
| Author |
Kazumi Akasaka |
Department of Laboratory Medicine, Asahikawa Medical College |
| Author |
Kenjiro Kikuchi |
Department of Cardiovascular Medicine, Hokkaido Cardiology Hospital |
| Author |
Naoyuki Hasebe |
Division of Cardiology, Nephrology, Pulmonology, and Neurology, Internal Medicine, Asahikawa Medical College |
| [ Summary ] |
The relationship between blood pressure (BP) control and mortality in hemodialysis patients remains controversial. Hypertension is considered to be the most important risk factor for development of cardiovascular complications that are the main cause of morbidity and mortality in hemodialysis patients. In contrast, lower BP is associated with higher mortality. This paradoxical association is referred to as the "U-shaped phenomenon".
High systolic BP in dialysis patients is often volume dependent, and is associated with increased pulse pressure, which has been shown to be a major predictor of mortality in dialysis patients. Hypotension in dialysis patients can be classified into intradialytic hypotension, persistent hypotension and orthostatic hypotension. It is thought that the major causes of hemodialysis-associated hypotension include impaired sympathetic responses, old age, malnutrition, inflammation, atherosclerosis, poor cardiac reserves, and removal of excess volumes of fluid. The important points concerning BP control are the suppression of interdialysis body weight gains and the determination of optimum dry weight. Furthermore, it is necessary to use appropriate tools to prevent hypertension or hypotension. A further interventional study is necessary to determine whether preventing hemodialysis-associated hypotension will improve the prognosis for hemodialysis patients. |