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Hypertension in Pediatric Dialysis Patients: Etiology, Evaluation, and Management

  • Raj Munshi
  • Joseph T. Flynn
Pediatric Hypertension (B Falkner, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pediatric Hypertension

Abstract

Purpose of Review

Review epidemiology, pathophysiology, and management of hypertension in the pediatric dialysis population.

Recent Findings

Interdialytic blood pressure measurement, especially with ambulatory blood pressure monitoring, is the gold standard to assess for hypertension. Tools to assess dry weight aid in achievement of euvolemia, the primary therapy for management of hypertension. Persistent hypertension should be treated with antihypertensive medications and potentially with native nephrectomies.

Summary

Cardiovascular disease continues to be the primary cause of morbidity and mortality in the dialysis population with hypertension as an important modifiable factor. Achievement on dry weight and limiting both aggressiveness of interdialytic weight gain and ultrafiltration rate underlie the best approach. Tools to assess volume status beyond clinical assessment have shown promise in achieving euvolemia. When hypertension persists despite achievement of euvolemia, antihypertensive medications may be required and in some cases native nephrectomies. Future studies in children are needed to determine the best antihypertensive class and ideal rate of ultrafiltration on hemodialysis towards achievement of normotension and reduction of cardiovascular risk.

Keywords

Pediatric dialysis Hypertension Hemodialysis Peritoneal dialysis Cardiovascular disease 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare no conflicts of interest relevant to this manuscript.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance

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© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Seattle Children’sSeattleUSA

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