Physiological Mechanisms of Hypertension and Cardiovascular Disease in End-Stage Kidney Disease

Curr Hypertens Rep. 2022 Oct;24(10):413-424. doi: 10.1007/s11906-022-01203-7. Epub 2022 Jun 16.

Abstract

Purpose of review: In this article, we summarize recent advances in understanding hypertension and cardiovascular disease in patients with end-stage kidney disease.

Recent findings: Factors such as anemia, valvular and vascular calcification, vasoconstrictors, uremic toxins, hypoglycemia, carbamylated proteins, oxidative stress, and inflammation have all been associated with the progression of cardiovascular disease in end-stage kidney disease but the causality of these mechanisms has not been proven. The high risk of cardiovascular mortality has not improved as in the general population despite many advancements in cardiovascular care over the last two decades. Mechanisms that increase hypertension risk in these patients are centered on the control of extracellular fluid volume; however, over-correction of volume with dialysis can increase risks of intradialytic hypotension and death in these patients. This review presents both recent and classic work that increases our understanding of hypertension and cardiovascular disease in end-stage kidney disease.

Keywords: Dialysis; End-stage kidney disease; Hypertension.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Cardiovascular Diseases* / complications
  • Humans
  • Hypertension* / etiology
  • Kidney Failure, Chronic* / complications
  • Kidney Failure, Chronic* / therapy
  • Renal Dialysis / adverse effects
  • Vasoconstrictor Agents

Substances

  • Vasoconstrictor Agents