How Do I Manage Hypertension in Patients with Advanced Chronic Kidney Disease Not on Dialysis? Perspectives from Clinical Practice

Abstract

Erietta Polychronopoulou,1 Gregoire Wuerzner,1,2 Michel Burnier1,2 1Service of Nephrology and Hypertension, University Hospital, Lausanne, Switzerland; 2Hypertension Research Foundation, Saint-Légier, SwitzerlandCorrespondence: Michel BurnierService of Nephrology and Hypertension, University Hospital, Rue du Bugnon 17, Lausanne 1011, SwitzerlandEmail [email protected]: In the general population, the prevalence of moderate and severe chronic kidney disease (CKD) is usually below 5% but this figure is often higher in specific groups of patients such as those with type 2 diabetes. Patients with advanced CKD (CKD stage 3b and 4) are at high or very high cardiovascular risk, and their risk of progressing towards end-stage kidney disease (CKD stage 5) and the need of renal replacement therapy are elevated. Hypertension is a major cause of poor cardiovascular and renal outcomes in severe CKD. Therefore, an adequate control of blood pressure (BP) is mandatory. However, normalizing BP is often challenging in these patients because the clinical management of hypertension in advanced CKD is not well defined and rarely supported by large randomized controlled trials. In the present review, we discuss the characteristics of hypertension in advanced CKD, excluding dialysis, and its management integrating data from recent clinical studies and a pragmatic approach enriched by a long-standing clinical experience.Keywords: hypertension, chronic kidney disease, CKD stage 3b-4, blockers of the renin-angiotensin, diuretics, calcium antagonists, SGLT2 inhibitors

Keywords

• hypertension
• chronic kidney disease
• ckd stage 3b-4
• blockers of the renin-angiotensin
• diuretics
• calcium antagonists
• sglt2 inhibitors