Abstract:
:Despite having thousands of blood pressure (BP) readings on individual dialysis patients over the course of a year, our knowledge about the optimal assessment of BP, the mechanisms underlying hypertension and its management remain incomplete. Observational studies reveal that BP is lower at home than when measured in the dialysis unit. However, we do not know if using home vs. in-center measurements to guide treatment decisions improves BP control and/or clinical outcomes. Moreover, a recent US study suggests that typical hemodialysis patients are unlikely to adhere to home monitoring over the long term. Volume excess is one of probably many factors mediating hypertension in this population. A randomized clinical trial of aggressively challenging dry weight in patients without overt signs of fluid overload was shown to reduce BP, but there was an increase in vascular access thrombosis and intradialytic hypotension episodes. Long-term studies have not been done; thus, we do not know whether "squeezing dry weight" as a means to control BP is of more benefit than harm. Daily or prolonged nocturnal dialysis consistently has been shown to lower BP. To what extent this is a result of enhanced solute clearance vs. removal of excess volume is not clear. Use of bioimpedance or relative blood volume monitoring to guide fluid management has been tested in small studies, but more data are needed to determine whether their use impacts clinical outcomes. Well-designed clinical trials to determine whether a specific antihypertensive drug class is of benefit, independent of BP lowering, are lacking. The BP target that optimizes outcomes HD patients is also unknown. Observational studies consistently show poorer survival with predialysis BP <140/90 mmHg, although such studies likely are confounded by low BP due to cardiovascular disease and other comorbidities. In this review, we discuss what is known and the questions that remain regarding the epidemiology, diagnosis, etiology, and management of hypertension in hemodialysis patients.
journal_name
Semin Dialjournal_title
Seminars in dialysisauthors
Miskulin DC,Weiner DEdoi
10.1111/sdi.12586subject
Has Abstractpub_date
2017-05-01 00:00:00pages
203-212issue
3eissn
0894-0959issn
1525-139Xjournal_volume
30pub_type
杂志文章,评审abstract::Mounting evidence supports a strong association between fluid management and outcomes among individuals receiving maintenance hemodialysis. The speed of fluid removal during dialysis (ultrafiltration, UF) is a modifiable aspect of fluid management that has attracted recent attention as a potential performance measure ...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12529
更新日期:2016-11-01 00:00:00
abstract::Translumbar tunneled dialysis catheter (TLDC) is a temporary dialysis access for patients exhausted traditional access for dialysis. While few small studies reported successes with TLDC, additional studies are warranted to understand the short- and long-term patency and safety of TLDC. We conducted a retrospective ana...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12358
更新日期:2015-07-01 00:00:00
abstract::For patients who require hemodialysis, beta blockers offer a simultaneous opportunity and challenge in the treatment of cardiovascular disease. Beta blockers are well supported by data from nondialysis populations and directly mitigate the sympathetic overactivity that links chronic kidney disease with cardiovascular ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12691
更新日期:2018-05-01 00:00:00
abstract::Caring for patients with end-stage kidney disease (ESKD) in the United States is challenging, due in part to the complex epidemiology of the disease's progression as well as the ways in which care is delivered. As CKD progresses toward ESKD, the number of comorbidities increases and care involves multiple healthcare p...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12929
更新日期:2020-11-01 00:00:00
abstract::Hemodialysis patients are susceptible to coronavirus disease 2019 (COVID-19). The aim of this study was to describe the epidemiological, clinical characteristics, and mortality-related risk factors for those who undergoing hemodialysis with COVID-19. We conducted a retrospective study. A total of 49 hemodialysis patie...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12928
更新日期:2020-10-29 00:00:00
abstract:INTRODUCTION:Protein-energy wasting (PEW) is common in hemodialysis patients and is linked with a high rate of morbidity and mortality. Regarding importance of nutrition in these patients, a recent study was administered to evaluate the nutritional status of hemodialysis patients. MATERIALS:In this cross-sectional stu...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12917
更新日期:2020-10-14 00:00:00
abstract::Although many nephrologists see value in maximizing clearance and time on dialysis, clinical trials have failed to show a clear and consistent benefit of increasing clearance above the minimum threshold level recommended in clinical practice guidelines or of increasing dialysis session length or frequency. Available e...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12938
更新日期:2020-11-01 00:00:00
abstract::Managing an end-stage renal disease (ESRD) patient is complex and presents many ethical challenges for the physician. Ownership of dialysis facilities has shifted over the past decade from largely nonprofit organizations to large companies whose shareholders are primarily interested in the profitability of their inves...
journal_title:Seminars in dialysis
pub_type: 社论
doi:10.1111/j.1525-139x.2004.17102.x
更新日期:2004-01-01 00:00:00
abstract::Recombinant human erythropoietin (rHuEPO, epoetin) revolutionized the treatment of anemia in patients with chronic kidney disease (CKD) when it was approved for use in the United States in 1989. Among dialysis patients, the mean hemoglobin (Hb) in patients undergoing dialysis rose from 7-8 g/dl prior to 1989 to 11-12 ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2005.18105.x
更新日期:2005-01-01 00:00:00
abstract::The use of stents has been steadily increasing in the management of dialysis access dysfunction. The purpose of this report was to review the use of covered stents in failed forearm fistulas and describe a case of the use of a small caliber forearm covered stent in a early failed forearm fistula that allowed dialysis ...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2008.00473.x
更新日期:2009-01-01 00:00:00
abstract::To prevent pyrogenic reactions during hemodialysis, it is recommended that bacteria and endotoxin in dialysate not exceed 100-200 colony forming units (CFU)/ml and 0.25-2 endotoxin units (EU)/ml, respectively. While these limits are adequate to prevent acute pyrogenic reactions, data are accumulating to suggest they m...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.0894-0959.2004.17617.x
更新日期:2004-11-01 00:00:00
abstract::Elderly individuals comprise an ever-increasing proportion of patients on renal replacement therapy (RRT). As in younger patients, cardiovascular events are the major cause of death in the elderly on RRT, although the relative proportion succumbing to cardiovascular events is similar to that in young patients. An impo...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2002.00037.x
更新日期:2002-03-01 00:00:00
abstract::Growing evidence has been gathered over the last 15 years regarding the role of nontraditional or uremia-related risk factors in the pathogenesis of atherosclerosis in subjects with renal failure. Among those factors, dyslipidemia, inflammation, hyperhomocysteinemia, and oxidant stress have been extensively studied. H...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2003.16031.x
更新日期:2003-03-01 00:00:00
abstract::There are studies reporting that soluble kltho (sKlotho) deficiency plays a role in cardiovascular disease in addition to traditional risk factors such as diabetes, hypertension, anemia, smoking, and excessive volume burden. Our aim in this study was to investigate the relationship of sKlotho with uremic cardiomyopath...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12942
更新日期:2020-11-30 00:00:00
abstract::The elderly people, 65 years old and above, are growing in number. The structural and functional changes associated with aging place the elderly at risk when challenged by extracorporeal therapies, such as therapeutic plasma exchange (TPE). We retrospectively analyzed data on all patients who underwent TPE for renal i...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.1525-139X.2011.01027.x
更新日期:2012-03-01 00:00:00
abstract::Few elderly patients with end-stage renal disease (ESRD) are treated with peritoneal dialysis (PD). Among dialysis patients >or=65 years of age reported by the U.S. Renal Data System (USRDS), the percentage treated with chronic peritoneal dialysis (CPD) is lower than in any other age group. To evaluate the effectivene...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1046/j.1525-139x.2002.00106.x
更新日期:2002-11-01 00:00:00
abstract::Late referral of patients with chronic kidney disease (CKD) and end-stage renal disease (ESRD) for evaluation of kidney transplantation is common. Even though renal transplantation offers a clear survival benefit to patients with advanced CKD and ESRD and should be considered the renal replacement therapy of choice, n...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12497
更新日期:2016-07-01 00:00:00
abstract::Cancer and kidney disease are linked by causality and comorbidities. Observational data show an increased risk of malignancy as renal function declines. Erythropoietin stimulating agents (ESAs), which are the cornerstone therapy for anemia patients with chronic kidney disease and cancer, are associated with increased ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12841
更新日期:2019-11-01 00:00:00
abstract::Presternally exiting peritoneal dialysis (PD) catheters have been described as advantageous compared to abdominally exiting catheters with regard to infection, wound healing, and other complications. Placement of such catheters has only been described with open surgical techniques and not by percutaneous means. In thi...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/j.0894-0959.2004.17356.x
更新日期:2004-09-01 00:00:00
abstract::Dialysis remains the predominant form of renal replacement therapy in the United States, but the optimal timing for the initiation of dialysis remains poorly defined. Not only clinical factors such as signs/symptoms of uremia, co-existing cardiovascular disease, and presence of diabetes but also key demographic charac...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/sdi.12130
更新日期:2013-11-01 00:00:00
abstract::In addition to extracorporeal renal replacement strategies, which in chronic kidney disease (CKD) are largely reserved for the treatment of end-stage kidney failure, conservative measures can be taken to reduce concentration, effects, or both concentration and effects of uremic retention solutes. In this overview, we ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2009.00600.x
更新日期:2009-07-01 00:00:00
abstract::Dialysate leakage represents a major noninfectious complication of peritoneal dialysis (PD). An exit-site leak refers to the appearance of any moisture around the PD catheter identified as dialysate; however, the spectrum of dialysate leaks also includes any dialysate loss from the peritoneal cavity other than via the...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2001.00014.x
更新日期:2001-01-01 00:00:00
abstract::The etiology and management of intradialytic hypotension has become an increasingly complex issue. Volume depletion due to ultrafiltration remains the predominant underlying etiologic factor. However, patients vary markedly in their hemodynamic tolerance to fluid removal. While many risk factors have been identified, ...
journal_title:Seminars in dialysis
pub_type: 社论,评审
doi:10.1046/j.1525-139x.2002.00002.x
更新日期:2002-05-01 00:00:00
abstract::Hypermagnesemia is an uncommon electrolyte abnormality, due to the fact that magnesium toxicity is only seen in the setting of a massive exposure to exogenous magnesium, often in the setting of renal insufficiency. Here, we report a case of severe hypermagnesemia that resulted in complete paralysis that was secondary ...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12479
更新日期:2016-05-01 00:00:00
abstract::It has been clearly established that critically ill patients with sepsis require prompt fluid resuscitation. The optimal amount of fluid and when to taper this resuscitation is less clear. There is a growing evidence that fluid overload leads to acute kidney injury, and increased morbidity and mortality. A clinician's...
journal_title:Seminars in dialysis
pub_type: 社论,评审
doi:10.1111/sdi.12753
更新日期:2019-01-01 00:00:00
abstract::The aim of this study was to describe the range and extent of current procedural practices of Nephrologists and trainees in Australia and New Zealand with a specific focus on renal biopsy. A web-based survey was constructed based on a 2009 pilot survey conducted by the authors. The survey was distributed by email. A t...
journal_title:Seminars in dialysis
pub_type: 杂志文章
doi:10.1111/sdi.12072
更新日期:2013-11-01 00:00:00
abstract::Nephrogenic systemic fibrosis has now been linked to gadolinium-based contrast exposure in those with compromised kidney function. When present, symptoms can be quite devastating for the patient including severe pain and immobility. Unfortunately there is a lack of a universally effective therapy at this time and the ...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2007.00407.x
更新日期:2008-03-01 00:00:00
abstract::The rationale of temperature control during hemodialysis (HD) is to prevent heat accumulation, which increases body temperature and enhances hypotensive susceptibility. Treatments where thermal energy is neither delivered nor removed from the patient through the extracorporeal circulation (so-called extracorporeal the...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1046/j.1525-139x.2003.16103.x
更新日期:2003-11-01 00:00:00
abstract::Numerous designs for tunneled hemodialysis catheter have been developed in an effort to improve catheter function and survival. In this prospective randomized controlled study, 97 patients were randomized into the palindrome catheter group (PC, n = 47) and step-tip catheter group (SC, n = 50). Demographic characterist...
journal_title:Seminars in dialysis
pub_type: 杂志文章,随机对照试验
doi:10.1111/j.1525-139X.2012.01054.x
更新日期:2012-09-01 00:00:00
abstract::Kidney transplantation is the treatment of choice for most patients with end-stage renal disease (ESRD), with success rates greater than were envisioned as recently as a decade ago. Unfortunately this trend has created unprecedented demand for transplantable organs and new challenges for those desiring transplantation...
journal_title:Seminars in dialysis
pub_type: 杂志文章,评审
doi:10.1111/j.1525-139X.2005.00093.x
更新日期:2005-11-01 00:00:00