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The growing problem of intradialytic hypertension

Nature Reviews Nephrology volume 6, pages 41–48 (2010)Cite this article

Abstract

Intradialytic hypertension is not a rare complication of dialysis, with a prevalence of 5–15% among hemodialysis patients, and it seems to be associated with adverse outcomes. This complex phenomenon is not well understood, and many uncertainties exist regarding its pathophysiologic mechanisms and appropriate treatment strategies. Mechanisms that might be involved in the pathogenesis of intradialytic hypertension include extracellular volume overload, increased cardiac output, changes in electrolyte levels (particularly sodium), activation of the renin–angiotensin–aldosterone system, overactivity of the sympathetic nervous system, and endothelial cell dysfunction. Most current treatment strategies are based only on expert opinion and not on the results of randomized clinical trials, as very little data on the therapy of intradialytic hypertension are available. The most important treatment is adequate sodium and water removal, but reducing sympathetic hyperactivity and reducing endothelin-1 levels should also be considered. Well-designed, randomized clinical trials are urgently needed to better understand the pathophysiologic mechanisms of this complex phenomenon and to improve its diagnosis, prognosis and treatment.

Key Points

  • Intradialytic hypertension has a prevalence of 5–15% among patients on hemodialysis and seems to be associated with adverse outcomes

  • Mechanisms potentially involved in the onset of intradialytic hypertension include extracellular volume overload, increased cardiac output, changes in electrolyte levels, activation of the renin–angiotensin–aldosterone system and the sympathetic nervous system, and endothelial cell dysfunction

  • Very little data on the treatment of intradialytic hypertension exist; most current therapeutic strategies have been proposed from potential pathophysiologic mechanisms and are based purely on expert opinion

  • The most important treatment approach for intradialytic hypertension is adequate sodium and fluid removal; reducing sympathetic hyperactivity should also be considered

  • More information from well-conducted randomized controlled clinical trials is needed to determine pathophysiologic mechanisms and define the best treatment approach for intradialytic hypertension

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  1. Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Via dell'Eremo 9/11, 23900, Lecco, Italy

    Francesco Locatelli, Andrea Cavalli & Benedetta Tucci

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  1. Francesco Locatelli
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Correspondence to Francesco Locatelli.

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Locatelli, F., Cavalli, A. & Tucci, B. The growing problem of intradialytic hypertension. Nat Rev Nephrol 6, 41–48 (2010). https://doi.org/10.1038/nrneph.2009.200

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