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Hypertension in Dialysis Patients

1 

What is Blood Pressure?

Kalpten pompalanan kan, organlara oksijen ve besin taşıyabilmesi için atar damarlar içinde belirli bir basınçla hareket etmelidir. Bu basınç genellikle sabit bir aralıkta tutulur. Tansiyon ölçümünde, yüksek değer "büyük" veya "sistolik" kan basıncı olarak adlandırılırken, düşük değer "küçük" veya "diyastolik" kan basıncı olarak adlandırılır. Ortalama değerler büyük tansiyon için 120 mmHg, küçük tansiyon için ise 80 mmHg'dir. Kan basıncının 140/90 mmHg'yi aşması durumuna "yüksek tansiyon" veya "hipertansiyon" denir.

2

When Should Blood Pressure Be Measured?

  • Blood pressure should be measured in a comfortable and tension-free environment with a properly calibrated blood pressure monitor.

  • Sometimes dialysis patients may be asked to monitor their blood pressure at home. This helps to adjust antihypertensive therapy more effectively.

3

When Should Blood Pressure Not Be Measured?

  • After a meal

  • After smoking

  • After consuming alcohol

  • In cases of extreme excitement, sadness or anger

  • When using cold or flu medications

  • After exercise (should be measured after 20-25 minutes of rest.)

4

What is the Relationship Between Kidney Failure and High Blood Pressure?

Hypertension is common in patients with renal failure; approximately 80% of patients with chronic renal failure have hypertension. Hypertension contributes to the progression of renal damage, and antihypertensive therapy may slow the progression of renal failure.

5

​How Does High Blood Pressure Affect Organs?

High blood pressure accelerates atherosclerosis (hardening of the arteries) in all the vessels in the body. This can cause vital problems in many organs and systems. In addition, structural and functional changes develop in the heart, which constantly works against high pressure. Other factors that accelerate atherosclerosis and need to be corrected include high blood sugar in diabetic patients, smoking and high blood lipids.

6

Problems Associated with High Blood Pressure Include:

  • Kidney dysfunction over time

  • Enlargement of the left ventricle of the heart and risk of heart failure

  • Angina pectoris (chest pain) and heart attack risk due to atherosclerosis in the coronary arteries

  • Brain hemorrhages

  • Stroke risk due to atherosclerosis in the arteries leading to the brain

  • Vision loss due to problems in the eye vessels

  • Leg pain and scar formation due to narrowing of the leg arteries

7

Causes of Hypertension in Kidney Failure are as follows:

  • Excess water in the body

  • Salt accumulation

  • Parathyroid gland overactivity

  • Vascular changes

  • Accumulation of waste products

  • Overactivity or underactivity of systems involved in blood pressure regulation

  • Erythropoietin therapy

8

How to Prevent Hypertension in Kidney Patients?

In kidney patients, it is important to control body water as well as drug therapy to control blood pressure. Excess water and salt in the body increases blood pressure. Water accumulation occurs due to the kidneys not working properly and this condition is called hypervolemia.

9

Causes of Hypervolemia are as follows:

  • Healthy kidneys excrete fluid, but when they are diseased, fluid retention can occur.

  • Salt consumption contributes to hypervolemia by causing water retention and increasing thirst.

10

How to Understand That There Is Excess Fluid in the Body?

  • Blood pressure increases.

  • Weight gain is observed.

  • Swelling occurs in the legs, hands and around the eyes.

  • Fullness may be seen in the neck veins.

  • Breathing may become difficult.

  • You may need more pillows while lying down.

  • You may have difficulty climbing stairs.

  • Headaches may occur due to high blood pressure.

11

The First Things to Do When Hypertension is Detected in a Dialysis Patient are:

  • Dry weight should be considered higher than ideal.

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What to do for a dialysis patient with high blood pressure:

  • Various techniques are used to re-establish the ideal dry weight. Dialysis physicians usually provide controlled weight loss until blood pressure returns to normal.

  • To reduce dry weight:

  • Salt and water intake should be restricted; weight gain between dialysis sessions should be kept below 2-2.5 kg.

  • In patients who urinate, diuretics can be used to increase urine output.

  • Fluid withdrawn during dialysis can be increased slowly and in a controlled manner.

  • Dialysis may require an extension of the duration or additional dialysis sessions.

  • In rare cases, if blood pressure cannot be controlled, antihypertensive medications may be used.

13

What Patients Should Do to Keep Blood Pressure Under Control:

  • Keeping weight gain between dialysis sessions below 2-2.5 kg by adhering to salt and water restrictions.

  • Regularly monitoring blood pressure at home.

  • Attending dialysis sessions regularly and not leaving before completing the session.

  • Being understanding of increases in dialysis duration and frequency when dry weight is reduced.

  • Taking medications regularly.

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