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Hypertension in dialysis patients

Rajiv Agarwal, MD
William L Henrich, MD, MACP
Lionel U Mailloux, MD, FACP
Section Editors
Steve J Schwab, MD
George L Bakris, MD
Deputy Editor
Alice M Sheridan, MD


Hypertension is common among dialysis patients [1]. This topic reviews the epidemiology, pathogenesis, and treatment of hypertension in dialysis patients.

Hypertension among patients with acute or chronic kidney disease who are not on dialysis is discussed elsewhere. (See "Overview of hypertension in acute and chronic kidney disease" and "Antihypertensive therapy and progression of nondiabetic chronic kidney disease in adults".)

Hypertension in the general adult population is discussed elsewhere. (See "Overview of hypertension in adults" and "Choice of drug therapy in primary (essential) hypertension" and "Hypertension: Who should be treated?" and "What is goal blood pressure in the treatment of hypertension?".)


Hypertension is a common finding in dialysis patients. Prevalence estimates vary widely among studies because of differences in the definition of hypertension and in methods of measuring blood pressure (BP; ie, either before and after dialysis or using ambulatory BP recordings). Based upon multiple studies, over 50 to 60 percent of hemodialysis patients (up to 85 percent in some reports) and nearly 30 percent of peritoneal dialysis patients are hypertensive [2-6]. In one multicenter trial that included 2535 adult hemodialysis patients, the prevalence of hypertension, defined as one-week average predialysis systolic BP measurements 150 mmHg or diastolic BP 85 mmHg or the use of antihypertensive medications, was 86 percent [5,6].

Hypertension is more common among patients who are just initiating dialysis (greater than 80 percent) because almost all such patients are volume overloaded [7]. Persistent hypertension often reflects inadequate volume control despite the initiation of dialysis [4,8]. (See 'Pathogenesis' below.)


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Literature review current through: Sep 2016. | This topic last updated: Oct 14, 2016.
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