Hypertension Management in Transition: From CKD to ESRD

Adv Chronic Kidney Dis. 2016 Jul;23(4):255-61. doi: 10.1053/j.ackd.2016.02.002.

Abstract

Hypertension is present in ∼90% of patients in late-stage CKD. There are scarce data focusing on the transition period between CKD Stages 4 and 5 (end-stage kidney disease) as it relates to hypertension evaluation and management. Here, we propose that a combination of the principles used in the management of patients with CKD Stages 4 and 5 be applied to patients in this transition. These include the use of out-of-office blood pressure (BP) monitoring (eg, home BP), avoidance of excessively tight BP goals, emphasis of sodium restriction, preferential use of blockers of the renin-angiotensin system and diuretics, and consideration of the use of beta blockers.

Keywords: CKD; Hypertension.

Publication types

  • Review

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Angiotensin Receptor Antagonists / therapeutic use
  • Angiotensin-Converting Enzyme Inhibitors / therapeutic use
  • Antihypertensive Agents / therapeutic use*
  • Blood Pressure
  • Blood Pressure Monitoring, Ambulatory
  • Calcium Channel Blockers / therapeutic use
  • Diet, Sodium-Restricted
  • Disease Progression
  • Diuretics / therapeutic use
  • Hypertension / complications
  • Hypertension / diet therapy
  • Hypertension / drug therapy*
  • Kidney Failure, Chronic / complications
  • Kidney Failure, Chronic / physiopathology
  • Mineralocorticoid Receptor Antagonists / therapeutic use
  • Renal Insufficiency, Chronic / complications
  • Renal Insufficiency, Chronic / physiopathology*

Substances

  • Adrenergic beta-Antagonists
  • Angiotensin Receptor Antagonists
  • Angiotensin-Converting Enzyme Inhibitors
  • Antihypertensive Agents
  • Calcium Channel Blockers
  • Diuretics
  • Mineralocorticoid Receptor Antagonists