Hypertension in chronic kidney disease: What you need to know

The article was professionally consulted with Specialist Doctor I Le Thanh An - Cardiac Interventionist - Department of Medical Examination & Internal Medicine - Vinmec Nha Trang International General Hospital.

Chronic renal failure is the most common cause of secondary hypertension, and conversely, hypertension is an independent risk factor for progression of CKD and cardiovascular mortality in patients with CKD. Blood pressure needs to be controlled to avoid chronic kidney failure. At the same time, it is necessary to treat chronic renal failure well to limit hypertension.

Hypertension is present in about 80-85% of patients with chronic kidney disease (CKD). The prevalence of hypertension is increased in patients with renal impairment and normal glomerular filtration rate (GFR) and increases further with decreased GFR. For example, data from the Modification of Diet in Renal Disease Study show that the prevalence of hypertension increases gradually from 65 to 95% when the GFR falls from 85 to 15 mL/min/1.73 m2. For patients without kidney disease, the prevalence of hypertension was also higher in patients with higher weight and in black patients.
A variety of factors may contribute to the increased prevalence of hypertension in patients with CKD:
Sodium retention is often of primary importance, although the degree of extracellular volume retention may not be sufficient to cause edema . Increased activity of the renin-angiotensin system is often at least partially responsible for hypertension, which persists after the restoration of normal volume, particularly in patients with vascular disease, because of anemia. Localization in the kidney is a potent stimulant of renin secretion. Regional ischemia due to scarring may also play a role. Hypertension may be a causative agent (eg, atherosclerotic renal disease) or a contributing factor to the development of kidney disease. Hypertension may be due to increased sympathetic nervous system activity. The afferent signal may arise partially within the failing kidney as it is not seen in patients who have undergone bilateral nephrectomy. Secondary hyperparathyroidism increases intracellular calcium levels, which can lead to vasoconstriction and hypertension. Reduction of parathyroid hormone secretion by long-term use of an active vitamin D analogue may decrease both intracellular calcium and systemic blood pressure. Erythropoietin treatment may increase blood pressure, an effect that is related in part to elevated hematocrit levels. Impaired nitric oxide synthesis and endothelial-mediated vasodilation have been demonstrated in patients with uremia.

When high blood pressure is left untreated for a long time, the risk of chronic kidney failure is certain. Visiting the doctor, the doctor will ask the patient to have tests to evaluate kidney function including:
Quantification of blood creatinine to assess the kidney's ability to filter blood from here can know kidney function, urine test to see whether there is protein, when there is protein in the urine is a sign that the kidneys have been damaged, the higher the amount of protein, the more severe the kidney damage is, and you may also have heart damage. If you already have kidney failure, then in addition to testing to check for GFR and urine protein, you need to do more tests: Ultrasound to check kidneys for abnormalities in size, structure or blockage, electrocardiogram Heart function test chart, blood glucose test, lipid (fat, cholesterol) blood test, weight and height check to calculate BMI. Once a stable treatment regimen is followed, frequent medical visits may not be necessary. Patients only need to see a doctor in the following cases: starting a new drug, having to change the dose of the drug, kidney disease worsens, blood pressure cannot be controlled...
This stage is beyond The tests to assess the degree of kidney failure, the patient is also measured the amount of potassium in the blood, because when the kidneys are impaired, the amount of potassium can increase in the blood, which is very dangerous for the heart.

The treatment goals to be achieved are: control blood pressure below 130/80 mmHg, prevent kidney damage from further damage, reduce the risk of heart disease. Achieving these goals requires following a treatment regimen appropriate for CKD.
Need to combine diet and make a lifestyle suitable for each stage of kidney failure:
If in stage 1-2 you eat a diet rich in fruits, vegetables, dairy. Stage 2-3 need to eat less than 2,400mg a day, reduce fat and cholesterol because they increase the risk of heart disease. Stage 3-4 to limit bone diseases, need to control protein intake, eat very little phosphorus-rich foods (because it will increase the risk of bone disease) such as milk, cheese, yogurt, beer, etc. coca, reduce the amount of potassium in the meal. In addition, it is necessary to lose weight if you are too fat, you should exercise gently for 30 minutes a day, do not drink alcohol, do not use tobacco. Using combination antihypertensive drugs of two or more types, along with diuretics. Never quit smoking on your own. Certain medications for high blood pressure and chronic kidney failure can also increase potassium levels. The doctor will prescribe a diet plan if the amount of potassium in the blood is high.
Avoid letting high blood pressure cause kidney failure to make treatment more difficult. Therefore, it is necessary to have good control of blood pressure index, timely examination when detecting abnormal blood pressure indicators.
Vinmec International General Hospital provides customers with a hypertensive examination package to check blood pressure measurements to assess health status and take timely interventions.
If there is a need for consultation and examination at the Hospitals of the national health system, please book an appointment on the website to be served.