Progress of research on target value of blood pressure in patients undergoing hemodialysis

doi:10.3877/cma.j.issn.2095-3216.2023.03.009

Abstract

Abstract:

Hemodialysis (HD) is the most widely used renal replacement therapy in the world. The first cause of death in HD patients is cardiovascular disease, which is closely related to the blood pressure. Blood pressure control is very important. At present, there is no unified opinion on the target value of blood pressure management in HD patients in the world. This article reviewed the progress of research on relationship between target value of blood pressure management and clinical prognosis in HD patients.

Key words: Hypertension, Target value, Prognosis

Xiaochen Li, Xi Qiao. Progress of research on target value of blood pressure in patients undergoing hemodialysis[J]. Chinese Journal of Kidney Disease Investigation(Electronic Edition), 2023, 12(03): 168-171.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhsbyjdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3216.2023.03.009

https://zhsbyjdzzz.cma-cmc.com.cn/EN/Y2023/V12/I03/168

Figures/Tables 1

References 37

[1]	Kalantar-Zadeh K, Jafar TH, Nitsch D, et al. Chronic kidney disease [J]. Lancet, 2021, 398(10302): 786-802.
[2]	GBD Chronic Kidney Disease Collaboration. Global, regional, and national burden of chronic kidney disease, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017 [J]. Lancet, 2020, 395(10225): 709-733.
[3]	Foreman KJ, Marquez N, Dolgert A, et al. Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories [J]. Lancet, 2018, 392(10159): 2052-2090.
[4]	Jankowski J, Floege J, Fliser D, et al. Cardiovascular disease in chronic kidney disease: pathophysiological insights and therapeutic options [J]. Circulation, 2021, 143(11): 1157-1172.
[5]	Jager KJ, Kovesdy C, Langham R, et al. A single number for advocacy and communication - worldwide more than 850 million individuals have kidney diseases [J]. Kidney Int, 2019, 96(5): 1048-1050.
[6]	Sarafidis PA, Persu A, Agarwal R, et al. Hypertension in dialysis patients: a consensus document by the European renal and cardiovascular medicine (EURECA-m) working group of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) and the hypertension and the kidney working group of the European Society of Hypertension (ESH) [J]. J Hypertens, 2017, 35(4): 657-676.
[7]	Pecoits-Filho R, Okpechi IG, Donner JA, et al. Capturing and monitoring global differences in untreated and treated end-stage kidney disease, kidney replacement therapy modality, and outcomes [J]. Kidney Int Suppl, 2020, 10(1): e3-e9.
[8]	中华医学会肾脏病学分会专家组. 中国慢性肾脏病患者高血压管理指南(2023年版)[J]. 中华肾脏病杂志，2023, 39(1): 48-80.
[9]	Thompson S, James M, Wiebe N, et al. Cause of death in patients with reduced kidney function [J]. J Am Soc Nephrol, 2015, 26(10): 2504-2511.
[10]	Bello AK, Okpechi IG, Osman MA, et al. Epidemiology of haemodialysis outcomes [J]. Nat Rev Nephrol, 2022, 18(6): 378-395.
[11]	Georgianos PI, Agarwal R. Blood pressure in hemodialysis: targets? [J]. Curr Opin Nephrol Hypertens, 2017, 26(6): 523-529.
[12]	Flythe JE, Chang TI, Gallagher MP, et al. Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) controversies conference [J]. Kidney Int, 2020, 97(5): 861-876.
[13]	Turner JM, Peixoto AJ. Blood pressure targets for hemodialysis patients [J]. Kidney Int, 2017, 92(4): 816-823.
[14]	中国医药教育协会肾病与血液净化专业委员会血液透析低血压防治专家组．血液透析中低血压防治专家共识(2022) [J]. 中华内科杂志，2022, 61(3): 269-281.
[15]	Miskulin DC, Gassman J, Schrader R, et al. BP in dialysis: results of a pilot study [J]. J Am Soc Nephrol, 2018, 29(1): 307-316.
[16]	Van Buren PN. Evaluation and treatment of hypertension in end-stage renal disease patients on hemodialysis [J]. Curr Cardiol Rep, 2016, 18(12): 125.
[17]	Zager PG, Nikolic J, Brown RH, et al. " U" curve association of blood pressure and mortality in hemodialysis patients. Medical Directors of Dialysis Clinic, Inc [J]. Kidney Int, 1998, 54(2): 561-569.
[18]	Robinson BM, Tong L, Zhang J, et al. Blood pressure levels and mortality risk among hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study [J]. Kidney Int, 2012, 82(5): 570-580.
[19]	Hannedouche T, Roth H, Krummel T, et al. Multiphasic effects of blood pressure on survival in hemodialysis patients [J]. Kidney Int, 2016, 90(3): 674-684.
[20]	Port FK, Hulbert-Shearon TE, Wolfe RA, et al. Predialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients [J]. Am J Kidney Dis, 1999, 33(3): 507-517.
[21]	Kalantar-Zadeh K, Kilpatrick RD, McAllister CJ, et al. Reverse epidemiology of hypertension and cardiovascular death in the hemodialysis population: the 58th annual fall conference and scientific sessions [J]. Hypertension, 2005, 45(4): 811-817.
[22]	Li Z, Lacson E Jr, Lowrie EG, et al. The epidemiology of systolic blood pressure and death risk in hemodialysis patients [J]. Am J Kidney Dis, 2006, 48(4): 606-615.
[23]	Bansal N, McCulloch CE, Lin F, et al. Blood pressure and risk of cardiovascular events in patients on chronic hemodialysis: the CRIC study (Chronic Renal Insufficiency Cohort) [J]. Hypertension, 2017, 70(2): 435-443.
[24]	Agarwal R, Sinha AD. Cardiovascular protection with antihypertensive drugs in dialysis patients: systematic review and meta-analysis [J]. Hypertension, 2009, 53(5): 860-866.
[25]	Heerspink HJ, Ninomiya T, Zoungas S, et al. Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials [J]. Lancet, 2009, 373(9668): 1009-1015.
[26]	Zoccali C, Mallamaci F. Cardiovascular protection by β-blockade in hypertensive haemodialysis patients: the hypertension in haemodialysis patients treated with atenolol or lisinopril (HDPAL) trial [J]. Nephrol Dial Transplant, 2014, 29(3): 483-485.
[27]	Quencer KB, Oklu R. Hemodialysis access thrombosis [J]. Cardiovasc Diagn Ther, 2017, 7(Suppl 3): S299-S308.
[28]	McCallum W, Sarnak MJ. Blood pressure target for the dialysis patient [J]. Semin Dial, 2019, 32(1): 35-40.
[29]	Hemodialysis Adequacy 2006 Work Group. Clinical practice guidelines for hemodialysis adequacy, update 2006 [J]. Am J Kidney Dis, 2006, 48(Suppl 1): S2-S90.
[30]	National Kidney Foundation. KDOQI clinical practice guideline for hemodialysis adequacy: 2015 update [J]. Am J Kidney Dis, 2015, 66(5): 884-930.
[31]	Jindal K, Chan CT, Deziel C, et al. Hemodialysis clinical practice guidelines for the Canadian Society of Nephrology [J]. J Am Soc Nephrol, 2006, 17(3 Suppl 1): S1-S27.
[32]	Hirakata H, Nitta K, Inaba M, et al. Japanese Society for Dialysis Therapy guidelines for management of cardiovascular diseases in patients on chronic hemodialysis [J]. Ther Apher Dial, 2012, 16(5): 387-435.
[33]	Davenport A, Cox C, Thuraisingham R. Achieving blood pressure targets during dialysis improves control but increases intradialytic hypotension [J]. Kidney Int, 2008, 73(6): 759-764.
[34]	SPRINT Research Group; Wright JT Jr, Williamson JD, et al. A randomized trial of intensive versus standard blood-pressure control [J]. N Engl J Med, 2015, 373(22): 2103-2116.
[35]	Cheung AK, Chang TI, Cushman WC, et al. Executive summary of the KDIGO 2021 clinical practice guideline for the management of blood pressure in chronic kidney disease [J]. Kidney Int, 2021, 99(3): 559-569.
[36]	中华医学会肾脏病学分会，中关村肾病血液净化创新联盟. 中国透析患者慢性心力衰竭管理指南[J]. 中华肾脏病杂志，2022, 38(5): 465-496.
[37]	高血压肾病诊治中国专家共识组成员. 高血压肾病诊断和治疗中国专家共识(2022) [J]. 中华高血压杂志，2022, 30(4): 307-317.

指南	血压靶目标
2005年K/DOQI指南^[13,29]	透析前血压<140/90 mmHg
	透析后血压<130/80 mmHg
2015年K/DOQI指南更新^[30]	没有足够的临床数据支持特定的血压目标
2006年加拿大肾脏病学会指南^[31]	透析前血压<140/90 mmHg
2012年日本透析治疗学会指南^[32]	透析前血压<140/90 mmHg
英国肾脏协会标准委员会^[33]	透析前血压目标<140/90 mmHg
	透析后血压目标<130/80 mmHg
2021KDIGO临床实践指南：慢性肾脏病患者的血压管理^[35]	没有明确的血压目标推荐
《中国透析患者慢性心力衰竭管理指南(2021年版)》^[36]	透析前血压<140/90 mmHg
	透析后血压<130/80 mmHg
《中国高血压肾病诊断的治疗专家共识(2022年版)》^[37]	SBP需控制在130~160 mmHg之间

指南	血压靶目标
2005年K/DOQI指南^[13,29]	透析前血压<140/90 mmHg
	透析后血压<130/80 mmHg
2015年K/DOQI指南更新^[30]	没有足够的临床数据支持特定的血压目标
2006年加拿大肾脏病学会指南^[31]	透析前血压<140/90 mmHg
2012年日本透析治疗学会指南^[32]	透析前血压<140/90 mmHg
英国肾脏协会标准委员会^[33]	透析前血压目标<140/90 mmHg
	透析后血压目标<130/80 mmHg
2021KDIGO临床实践指南：慢性肾脏病患者的血压管理^[35]	没有明确的血压目标推荐
《中国透析患者慢性心力衰竭管理指南(2021年版)》^[36]	透析前血压<140/90 mmHg
	透析后血压<130/80 mmHg
《中国高血压肾病诊断的治疗专家共识(2022年版)》^[37]	SBP需控制在130~160 mmHg之间

Please choose a citation manager

Content to export