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Eloot S, Van Biesen W, Dhondt A, et al. Impact of hemodialysis duration on the removal of uremic retention solutes. Kidney Int. 2008;73:765-770. Wolf-Maier K, Cooper RS, Banegas JR, Giampaoli S, Hense HW, Joffres M, et al. Hypertension prevalence and blood pressure levels in 6 European countries, Canada, and the United States. JAMA 2003;289:2363-9. The reported benefits of home hemodialysis may not be experienced by all patients. Despite the health benefits that home and more frequent hemodialysis may provide to those with chronic kidney disease, these forms of therapy are not for everyone. Future refinement of this classification may cover also vascular changes (cerebral, peripheral, renal) also very frequent in hypertensive patients and ususally a challenge for practitioners. 6 - Self training The main cause of hypertensive heart disease is elevated peripheral vascular resistance and arterial hypertension. Radiographic features
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Ting GO, Kjellstrand C, Freitas T, Carrie BJ, Zarghamee S. Long-term study of high-comorbidity ESRD patients converted from conventional to short daily hemodialysis. Am J Kidney Dis. 2003;42(5):1020-1035. Those definitions seem incomplete. Although LVH and heart failure are the most typical cardiac complications of hypertension, many patients may however complain, especially at the beginning of the process, of other symptoms of heart involvement. At end stages arrhythmias and coronary ischaemia can also lead to a worsening of the clinical profile. The definition provided by Frohlich et al20 seems rather inadequate because, as is now well established, the hemodynamic mechanism is not the only one involved in the development of LHV21. All hemodialysis therapies also involve the use of medical devices that introduce the potential for additional risks including air entering the bloodstream, damage of red blood cells, inflammatory reactions, blood chemistry imbalances, blood loss due to clotting of the blood tubing set or accidental blood line disconnection or other leak, allergic reactions, and excess warming or cooling of the dialysate. In addition, dialysis patients may have other underlying diseases that may, in some cases, make it more difficult for them to manage their hemodialysis treatments.Pinciaroli AR. Restuls of daily hemodialysis in Catanzaro: 12-year experience with 22 patients treated for more than one year. Hemodial Int. 1998;2(1):12-17. Another part of the management includes lifestyle modifications and the control of other cardiovascular risk factors. Differential diagnosis
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Over 1.1 billion people worldwide, one-fourth of all men and one-fifth of all women suffer from hypertension and the condition is in control in less than 20% of the affected population. It is also the main risk factor and cause of hypertensive heart disease 1. Associations Ayus JC, Achinger SG, Mizani MR, et al. Phosphorus balance and mineral metabolism with 3 h daily hemodialysis. Kidney Int. 2007;71(4):336-342. Nocturnal hemodialysis is associated with improved quality of life and patient outcomes — including improved survival. Performing more frequent nocturnal hemodialysis has shown similar 5 year survivability as deceased donor transplantation. 21Kuruvilla S, Janardhanan R, Antkowiak P et al. Increased Extracellular Volume and Altered Mechanics Are Associated With LVH In Hypertensive Heart Disease, Not Hypertension Alone. JACC Cardiovasc Imaging. 2015;8(2):172-80. doi:10.1016/j.jcmg.2014.09.020 - Pubmed Subcommittee of WHO/ISH Mild Hypertension Liaison Committee. Summary of 1993 World Health Organisation-International Society of Hypertension: Guidelines for the management of mild hypertension. Br Med J 1993;307:1541-6. Possible symptoms include dyspnea, angina, syncope, heart failure or even sudden cardiac death. However, in the initial stages, most patients will be asymptomatic 3. More recent definitions have also linked HHD to LVH. Frohlich et al defined HHD as the cardiac response to the afterload imposed on the left ventricle by the progressive increase in arterial pressure and peripheral vascular resistance as a consequence of hypertensive vascular disease20. Struijker Boudier HA, Cohuet GM, Baumann M, Safar ME. The heart, macrocirculation and microcirculation in hypertension: a unifying hypothesis. J Hypertens Suppl 2003;21(Suppl 3):S19-23.
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