Chronic Renal Failure and Arterial Hypertension

Hypertension is a frequent and early component in the uremic syndrome. Extracellular volume expansion causes hypertension in approximately 75 % of patients with chronic renal failure and therefore is responsive to hemodialysis. The other major cause of hypertension in uremic patients is hyperreninemia. The degree of hypertension in this small group of patients is more extreme, is not responsive to volume manipulations by dialysis, and often will require bilateral nephrectomy. The route of excretion and drug-dosage alteration in hypertension treatment before initiation of dialysis are important. Indications for hemodialysis and bilateral nephrectomy for complicated hypertension and in preparation for renal transplantation vary in different programs. The increased incidence of cardiovascular death in chronic hemodialysis patients should modify these indications to obtain earlier and better control of hypertension.