Skip to content
2000
image of Blood Pressure Management in Dialysis: A Comparative Review of Hemodialysis and Peritoneal Dialysis
file format pdf download PDF

Abstract

Hypertension is a major challenge in patients with end-stage kidney disease (ESKD) undergoing dialysis, contributing to increased cardiovascular morbidity and mortality. Both hemodialysis (HD) and peritoneal dialysis (PD) serve as renal replacement therapies, yet their effectiveness in blood pressure (BP) control remains a subject of ongoing debate. Emerging evidence suggests that PD may offer better BP regulation than HD due to continuous ultrafiltration, superior sodium removal, and the preservation of residual kidney function. In contrast, HD is often associated with interdialytic fluid retention, leading to BP fluctuations and a higher risk of cardiovascular complications. However, BP control in PD patients is not without challenges, as ultrafiltration failure, peritoneal membrane dysfunction, and inflammation can contribute to resistant hypertension. Despite these limitations, PD may provide a more stable hemodynamic profile compared to HD, making it a promising option for patients with difficult-to-manage hypertension. Individualized dialysis selection remains crucial, as it balances the benefits of fluid control with the risks of PD-related complications. Further research, particularly randomized controlled trials, is needed to determine the long-term impact of PD and HD on BP control and cardiovascular outcomes in dialysis patients.

© 2025 The Author(s). Published by Bentham Science Publishers.
This is an open access article published under CC BY 4.0 https://creativecommons.org/licenses/by/4.0/legalcode.
Loading

Article metrics loading...

/content/journals/chyr/10.2174/0115734021408764250929235308
2025-10-16
2025-12-25

  • From This Site

    /content/journals/chyr/10.2174/0115734021408764250929235308
    dcterms_title,dcterms_subject,pub_keyword
    -contentType:Contributor -contentType:Concept -contentType:Institution
    10
    5
Loading full text...

Full text loading...

/deliver/fulltext/chyr/10.2174/0115734021408764250929235308/BMS-CHR-2025-43.html?itemId=/content/journals/chyr/10.2174/0115734021408764250929235308&mimeType=html&fmt=ahah

References

  1. Ortega L.M. Materson B.J. Hypertension in peritoneal dialysis patients: Epidemiology, pathogenesis, and treatment. J. Am. Soc. Hypertens. 2011 5 3 128 136 10.1016/j.jash.2011.02.004 21459067
    [Google Scholar]
  2. Vareta G. Georgianos P.I. Vaios V. Epidemiology of hypertension among patients on peritoneal dialysis using standardized office and ambulatory blood pressure recordings. Am. J. Nephrol. 2022 53 2-3 139 147 10.1159/000521861 35124679
    [Google Scholar]
  3. Tsikliras N. Georgianos P.I. Vaios V. Prevalence and control of hypertension among patients on haemodialysis. Eur. J. Clin. Invest. 2020 50 10 13292 10.1111/eci.13292 32463486
    [Google Scholar]
  4. Sarafidis P.A. Persu A. Agarwal R. Hypertension in dialysis patients. J. Hypertens. 2017 35 4 657 676 10.1097/HJH.0000000000001283 28157814
    [Google Scholar]
  5. Sarafidis P.A. Mallamaci F. Loutradis C. Prevalence and control of hypertension by 48-h ambulatory blood pressure monitoring in haemodialysis patients: A study by the European Cardiovascular and Renal Medicine (EURECA-m) working group of the ERA-EDTA. Nephrol. Dial. Transplant. 2019 34 9 1542 1548 10.1093/ndt/gfy147 30007295
    [Google Scholar]
  6. Alexandrou M.E. Loutradis C. Schoina M. Ambulatory blood pressure profile and blood pressure variability in peritoneal dialysis compared with hemodialysis and chronic kidney disease patients. Hypertens. Res. 2020 43 9 903 913 10.1038/s41440‑020‑0442‑0 32327730
    [Google Scholar]
  7. Flythe J.E. Chang T.I. Gallagher M.P. Blood pressure and volume management in dialysis: Conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference. Kidney Int. 2020 97 5 861 876 10.1016/j.kint.2020.01.046 32278617
    [Google Scholar]
  8. Kanno Y. Blood pressure management in patients receiving renal replacement therapy. Hypertens. Res. 2021 44 1 7 12 10.1038/s41440‑020‑00563‑4 33077906
    [Google Scholar]
  9. Levin N.W. Kotanko P. Eckardt K.U. Blood pressure in chronic kidney disease stage 5D—report from a Kidney Disease: Improving Global Outcomes controversies conference. Kidney Int. 2010 77 4 273 284 10.1038/ki.2009.469 20016467
    [Google Scholar]
  10. Aguirre A.R. Abensur H. Protective measures against ultrafiltration failure in peritoneal dialysis patients. Clinics (São Paulo) 2011 66 12 2151 2157 10.1590/S1807‑59322011001200023 22189743
    [Google Scholar]
  11. Symonides B. Kwiatkowska-Stawiarczyk M. Lewandowski J. Małyszko J.S. Małyszko J. Resistant and apparently resistant hypertension in peritoneally dialyzed patients. J. Clin. Med. 2025 14 1 218 10.3390/jcm14010218 39797299
    [Google Scholar]
  12. Heaf J. Pathogenic effects of a high peritoneal transport rate. Semin. Dial. 2000 13 3 188 193 10.1046/j.1525‑139x.2000.00051.x 10833780
    [Google Scholar]
  13. Li P.K.T. Chow K.M. Maximizing the success of peritoneal dialysis in high transporters. Perit. Dial. Int. 2007 27 2 Suppl. 148 152 10.1177/089686080702702s25 17556294
    [Google Scholar]
  14. Global action plan for the prevention and control of noncommunica-ble diseases 2013-2020. 2013 Available from: https://iris.who.int/handle/10665/94384
  15. Hamrahian S.M. Management of hypertension in patients with chronic kidney disease. Curr. Hypertens. Rep. 2017 19 5 43 10.1007/s11906‑017‑0739‑9 28451853
    [Google Scholar]
  16. Ramadhanti R. Helda H. Association of hypertension and chronic kidney disease in population aged ≥18 years old. Mol Cell Biomed Sci 2021 5 3 137 10.21705/mcbs.v5i3.219
    [Google Scholar]
  17. Ingsathit A. Thakkinstian A. Chaiprasert A. Prevalence and risk factors of chronic kidney disease in the Thai adult population: Thai SEEK study. Nephrol. Dial. Transplant. 2010 25 5 1567 1575 10.1093/ndt/gfp669 20037182
    [Google Scholar]
  18. Report on Result of National Basic Health Research (RISKESDAS) 2007 2007 Available from: https://repository.badankebijakan.kemkes.go.id/id/eprint/4386/1/Report%20on%20Result%20of%20National%20Basic%20Health%20Research%202007.pdf
  19. Report on Result of National Basic Health Research (RISKESDAS) 2013 2013 Available from:https://repository.badankebijakan.kemkes.go.id/id/eprint/4519/1/Basic_Health_Research_Riskesdas.pdf
  20. Basic Health Research (Riskesdas) 2018. 2018 Available from:https://layanandata.kemkes.go.id/katalog-data/riskesdas/ketersediaan-data/riskesdas-2018
  21. McEvoy J.W. McCarthy C.P. Bruno R.M. 2024 ESC Guidelines for the management of elevated blood pressure and hypertension. Eur. Heart J. 2024 45 38 3912 4018 10.1093/eurheartj/ehae178 39210715
    [Google Scholar]
  22. Davis T.K. Davis A.J. Ambulatory blood pressure monitoring should be used in the primary care setting to diagnose hypertension. Am. J. Hypertens. 2013 26 9 1057 1058 10.1093/ajh/hpt089 23747955
    [Google Scholar]
  23. Sebo P. Pechère-Bertschi A. Herrmann F.R. Haller D.M. Bovier P. Blood pressure measurements are unreliable to diagnose hypertension in primary care. J. Hypertens. 2014 32 3 509 517 10.1097/HJH.0000000000000058 24299914
    [Google Scholar]
  24. Minutolo R. Gabbai F.B. Agarwal R. Assessment of achieved clinic and ambulatory blood pressure recordings and outcomes during treatment in hypertensive patients with CKD: A multicenter prospective cohort study. Am. J. Kidney Dis. 2014 64 5 744 752 10.1053/j.ajkd.2014.06.014 25082100
    [Google Scholar]
  25. Cohen D.L. Huan Y. Townsend R.R. Home blood pressure monitoring in CKD. Am. J. Kidney Dis. 2014 63 5 835 842 10.1053/j.ajkd.2013.12.015 24529535
    [Google Scholar]
  26. Whelton P.K. Carey R.M. Aronow W.S. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: Executive summary: A report of the American college of Cardiology/American heart association task force on clinical practice guidelines. Hypertension 2018 71 6 1269 1324 10.1161/HYP.0000000000000066 29133354
    [Google Scholar]
  27. Ringrose J.S. Polley G. McLean D. Thompson A. Morales F. Padwal R. An assessment of the accuracy of home blood pressure monitors when used in device owners. Am. J. Hypertens. 2017 30 7 683 689 10.1093/ajh/hpx041 28430848
    [Google Scholar]
  28. Williams B. Mancia G. Spiering W. 2018 ESC/ESH Guidelines for the management of arterial hypertension. Eur. Heart J. 2018 39 33 3021 3104 10.1093/eurheartj/ehy339 30165516
    [Google Scholar]
  29. Bucharles S.G.E. Wallbach K.K.S. Moraes T.P. Pecoits-Filho R. Hypertension in patients on dialysis: Diagnosis, mechanisms, and management. J. Bras. Nefrol. 2019 41 3 400 411 10.1590/2175‑8239‑jbn‑2018‑0155 30421784
    [Google Scholar]
  30. Nongnuch A. Campbell N. Stern E. El-Kateb S. Fuentes L. Davenport A. Increased postdialysis systolic blood pressure is associated with extracellular overhydration in hemodialysis outpatients. Kidney Int. 2015 87 2 452 457 10.1038/ki.2014.276 25075771
    [Google Scholar]
  31. Fishbane S. Natke E. Maesaka J.K. Role of volume overload in dialysis-refractory hypertension. Am. J. Kidney Dis. 1996 28 2 257 261 10.1016/S0272‑6386(96)90309‑1 8768921
    [Google Scholar]
  32. Lins R.L. Elseviers M. Rogiers P. Importance of volume factors in dialysis related hypertension. Clin. Nephrol. 1997 48 1 29 33 9247775
    [Google Scholar]
  33. Flythe J.E. Bansal N. The relationship of volume overload and its control to hypertension in hemodialysis patients. Semin. Dial. 2019 32 6 500 506 10.1111/sdi.12838 31564065
    [Google Scholar]
  34. Loutradis C. Sarafidis P.A. Ferro C.J. Zoccali C. Volume overload in hemodialysis: Diagnosis, cardiovascular consequences, and management. Nephrol. Dial. Transplant. 2021 36 12 2182 2193 10.1093/ndt/gfaa182 33184659
    [Google Scholar]
  35. Bansal N. Artinian N.T. Bakris G. Hypertension in patients treated with in-center maintenance hemodialysis: Current evidence and future opportunities: A scientific statement from the American Heart Association. Hypertension 2023 80 6 e112 e122 10.1161/HYP.0000000000000230 37092336
    [Google Scholar]
  36. Van Buren P.N. Evaluation and treatment of hypertension in end-stage renal disease patients on hemodialysis. Curr. Cardiol. Rep. 2016 18 12 125 10.1007/s11886‑016‑0805‑y 27796862
    [Google Scholar]
  37. Kornerup H.J. Schmitz O. Danielsen H. Pedersen E.B. Giese J. Significance of the renin-angiotensin system for blood pressure regulation in end-stage renal disease. In: Jahn H, Massry SG, Ritz E,Weidmann P, Eds.Contributions to Nephrology. Jahn H. Massry S.G. Ritz E. Weidmann P. S. Karger AG 1985 123 127
    [Google Scholar]
  38. Henrich W.L. Katz F.H. Molinoff P.B. Schrier R.W. Competitive effects of hypokalemia and volume depletion on plasma renin activity, aldosterone and catecholamine concentrations in hemodialysis patients. Kidney Int. 1977 12 4 279 284 10.1038/ki.1977.112 599838
    [Google Scholar]
  39. Bazzato G. Coli U. Landini S. Lucatello S. Fracasso A. Morachiello P. Prevention of intra- and postdialytic hypertensive crises by captopril. In: Jahn H, Massry SG, Ritz E, Weidmann P, Eds.Contributions to Nephrology. Jahn H. Massry S.G. Ritz E. Weidmann P. S. Karger AG 1985 292 298
    [Google Scholar]
  40. Zanoli L. Lentini P. Briet M. Arterial stiffness in the heart disease of CKD. J. Am. Soc. Nephrol. 2019 30 6 918 928 10.1681/ASN.2019020117 31040188
    [Google Scholar]
  41. Kaur J. Young B. Fadel P. Sympathetic overactivity in chronic kidney disease: Consequences and mechanisms. Int. J. Mol. Sci. 2017 18 8 1682 10.3390/ijms18081682 28767097
    [Google Scholar]
  42. Neumann J. Ligtenberg G. Klein I.I. Koomans H.A. Blankestijn P.J. Sympathetic hyperactivity in chronic kidney disease: Pathogenesis, clinical relevance, and treatment. Kidney Int. 2004 65 5 1568 1576 10.1111/j.1523‑1755.2004.00552.x 15086894
    [Google Scholar]
  43. Vink E.E. de Jager R.L. Blankestijn P.J. Sympathetic hyperactivity in chronic kidney disease: Pathophysiology and (new) treatment options. Curr. Hypertens. Rep. 2013 15 2 95 101 10.1007/s11906‑013‑0328‑5 23354877
    [Google Scholar]
  44. Kiuchi M.G. Ho J.K. Nolde J.M. Sympathetic activation in hypertensive chronic kidney disease – A stimulus for cardiac arrhythmias and sudden cardiac death? Front. Physiol. 2020 10 1546 10.3389/fphys.2019.01546 32009970
    [Google Scholar]
  45. Wever R. Boer P. Hijmering M. Nitric oxide production is reduced in patients with chronic renal failure. Arterioscler. Thromb. Vasc. Biol. 1999 19 5 1168 1172 10.1161/01.ATV.19.5.1168 10323766
    [Google Scholar]
  46. Abraham P.A. Macres M.G. Blood pressure in hemodialysis patients during amelioration of anemia with erythropoietin. J. Am. Soc. Nephrol. 1991 2 4 927 936 10.1681/ASN.V24927 1751794
    [Google Scholar]
  47. Cocchi R. Degli Esposti E. Fabbri A. Prevalence of hypertension in patients on peritoneal dialysis: Results of an Italian multicentre study. Nephrol. Dial. Transplant. 1999 14 6 1536 1540 10.1093/ndt/14.6.1536 10383021
    [Google Scholar]
  48. Gokal R. Fluid management and cardiovascular outcome in peritoneal dialysis patients. Semin. Dial. 1999 12 2 126 132 10.1046/j.1525‑139X.1999.00003.x
    [Google Scholar]
  49. Günal A.I. Ilkay E. Kirciman E. Karaca I. Dogukan A. Celiker H. Blood pressure control and left ventricular hypertrophy in long-term CAPD and hemodialysis patients: A cross-sectional study. Perit. Dial. Int. 2003 23 6 563 567 10.1177/089686080302300608 14703197
    [Google Scholar]
  50. Riella M.C. Blood pressure control in dialysis patients: HD vs CAPD. Nefrologia 2002 22 49 51
    [Google Scholar]
  51. Krediet R.T. Ultrafiltration failure is a reflection of peritoneal alterations in patients treated with peritoneal dialysis. Front. Physiol. 2018 9 1815 10.3389/fphys.2018.01815 30618825
    [Google Scholar]
  52. Teitelbaum I. Ultrafiltration failure in peritoneal dialysis: A pathophysiologic approach. Blood Purif. 2015 39 1-3 70 73 10.1159/000368972 25661912
    [Google Scholar]
  53. Mehrotra R. Devuyst O. Davies S.J. Johnson D.W. The current state of peritoneal dialysis. J. Am. Soc. Nephrol. 2016 27 11 3238 3252 10.1681/ASN.2016010112 27339663
    [Google Scholar]
  54. Lingens N. Soergel M. Loirat C. Busch C. Lemmer B. Schärer K. Ambulatory blood pressure monitoring in paediatric patients treated by regular haemodialysis and peritoneal dialysis. Pediatr. Nephrol. 1995 9 2 167 172 10.1007/BF00860734 7794711
    [Google Scholar]
  55. Coomer R.W. Schulman G. Breyer J.A. Shyr Y. Ambulatory blood pressure monitoring in dialysis patients and estimation of mean interdialytic blood pressure. Am. J. Kidney Dis. 1997 29 5 678 684 10.1016/S0272‑6386(97)90119‑0 9159300
    [Google Scholar]
  56. Velasquez M.T. Lew S.Q. von Albertini B. Mishkin G.J. Bosch J.P. Control of hypertension is better during hemodialysis than during continuous ambulatory peritoneal dialysis in ESRD patients. Clin. Nephrol. 1997 48 6 341 345 9438091
    [Google Scholar]
  57. Tonbul Z. Altintepe L. Sözlü Ç. Yeksan M. Yildiz A. Türk S. Ambulatory blood pressure monitoring in haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients. J. Hum. Hypertens. 2002 16 8 585 589 10.1038/sj.jhh.1001449 12149665
    [Google Scholar]
  58. Yao Y.H. Fu C.H. Ho S.J. Peritoneal dialysis as compared with hemodialysis is associated with higher overhydration but non-inferior blood pressure control and heart function. Blood Purif. 2012 34 1 40 47 10.1159/000338964 22922709
    [Google Scholar]
  59. Zhao Y. Comparison of the effect of hemodialysis and peritoneal dialysis in the treatment of end-stage renal disease. Pak. J. Med. Sci. 2023 39 6 1562 1567 10.12669/pjms.39.6.8056 37936738
    [Google Scholar]
  60. Vaios V. Georgianos P.I. Liakopoulos V. Agarwal R. Assessment and management of hypertension among patients on peritoneal dialysis. Clin. J. Am. Soc. Nephrol. 2019 14 2 297 305 10.2215/CJN.07480618 30341090
    [Google Scholar]
  61. Devuyst O. Assessing transport across the peritoneal membrane: Precision medicine in dialysis. Perit. Dial. Int. 2021 41 4 349 351 10.1177/08968608211022236 34105414
    [Google Scholar]
  62. Zhou D. Lei H. Wu S. Influencing factors for residual kidney function in incident peritoneal dialysis patients: A systematic review and meta-analysis. Ren. Fail. 2023 45 2 2286328 10.1080/0886022X.2023.2286328 38036948
    [Google Scholar]
  63. Wang M. Obi Y. Streja E. Impact of residual kidney function on hemodialysis adequacy and patient survival. Nephrol. Dial. Transplant. 2018 33 10 1823 1831 10.1093/ndt/gfy060 29688442
    [Google Scholar]
/content/journals/chyr/10.2174/0115734021408764250929235308
Loading
Blood Pressure Management in Dialysis: A Comparative Review of Hemodialysis and Peritoneal Dialysis
Bentham Science Publishers ; https://doi.org/10.2174/0115734021408764250929235308
/content/journals/chyr/10.2174/0115734021408764250929235308
/content/journals/chyr/10.2174/0115734021408764250929235308
Loading

Data & Media loading...


  • Article Type:     Review Article
Keywords: hemodialysis ; hypertension ; Peritoneal dialysis ; volume management ; renal replacement therapy ; chronic kidney disease

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error
Please enter a valid_number test