Department of Nephrology, Dialysis and Renal Transplant, Alessandro Manzoni Hospital, Via dell'Eremo 9/11, 23900 Lecco, Italy.
Nat Rev Nephrol. 2010 Jan;6(1):41-8. doi: 10.1038/nrneph.2009.200. Epub 2009 Nov 24.
Intradialytic hypertension is not a rare complication of dialysis, with a prevalence of 5-15% among hemodialysis patients, and it seems to be associated with adverse outcomes. This complex phenomenon is not well understood, and many uncertainties exist regarding its pathophysiologic mechanisms and appropriate treatment strategies. Mechanisms that might be involved in the pathogenesis of intradialytic hypertension include extracellular volume overload, increased cardiac output, changes in electrolyte levels (particularly sodium), activation of the renin-angiotensin-aldosterone system, overactivity of the sympathetic nervous system, and endothelial cell dysfunction. Most current treatment strategies are based only on expert opinion and not on the results of randomized clinical trials, as very little data on the therapy of intradialytic hypertension are available. The most important treatment is adequate sodium and water removal, but reducing sympathetic hyperactivity and reducing endothelin-1 levels should also be considered. Well-designed, randomized clinical trials are urgently needed to better understand the pathophysiologic mechanisms of this complex phenomenon and to improve its diagnosis, prognosis and treatment.
透析中高血压并非透析的罕见并发症，在血液透析患者中其患病率为 5-15%，且似乎与不良结局相关。这一复杂现象尚未被充分理解，其病理生理机制和恰当治疗策略仍存在诸多不确定性。可能参与透析中高血压发病机制的机制包括细胞外液容量超负荷、心输出量增加、电解质水平（尤其是钠）变化、肾素-血管紧张素-醛固酮系统激活、交感神经系统过度活跃和内皮细胞功能障碍。目前大多数治疗策略仅基于专家意见，而非基于随机临床试验结果，因为关于透析中高血压治疗的数据非常有限。最重要的治疗是充分清除钠和水分，但也应考虑降低交感神经活性和降低内皮素-1水平。迫切需要精心设计的随机临床试验来更好地理解这一复杂现象的病理生理机制，并改善其诊断、预后和治疗。
