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Pathophysiology of Hypertension in Chronic Kidney Disease and Dialysis

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Core Concepts in Hypertension in Kidney Disease

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Abstract

The extremely high prevalence of hypertension in CKD is an expected consequence of the central role played by the kidneys in the regulation of body fluid volumes and BP homeostasis. Kidney disease, regardless of etiology, tends to impair the efficiency of the salt excretory mechanisms albeit to a variable degree. This results in an increased BP salt sensitivity with a general potentiation of the prohypertensive mechanisms and a blunting of the effectiveness of the antihypertensive mechanisms. Therefore, hypertension in CKD patients also tends to be more resistant and difficult to control. Nevertheless, although there is variability in the contribution of individual hypertensive pathways and the severity of resulting hypertension in different disease states associated with CKD, the pathways usually converge in Na retention and/or an inadequate suppression of RAS. Accordingly, regardless of the nature and complexity of the underlying pathogenesis of hypertension in CKD states, most such individuals are more responsive to therapeutic agents targeted to these pathways. Although difficult to achieve, effective BP control is necessary in these individuals to not only slow the further progression of CKD, but to also reduce the very high cardiovascular morbidity and mortality in these individuals.

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  1. Edward Hines Jr. VA Hospital and Loyola University Medical Center, 2160 South First Avenue, Bldg. 102, Room 3661, Maywood, IL, 60153, USA

    Karen A. Griffin MD, Aaron J. Polichnowski PhD & Anil K. Bidani MD

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    Ajay K. Singh

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    Rajiv Agarwal

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Griffin, K.A., Polichnowski, A.J., Bidani, A.K. (2016). Pathophysiology of Hypertension in Chronic Kidney Disease and Dialysis. In: Singh, A., Agarwal, R. (eds) Core Concepts in Hypertension in Kidney Disease. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-6436-9_3

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