Management of Hypertension in CKD
Management of Hypertension in CKD
Management of Hypertension in CKD
DR PRATIK TRIPATHI
D.M ( Nephrology)
Fortis Escorts Hospital
Jaipur
Definition of CKD
Structural or functional abnormalities of
the kidneys for >3 months, as manifested
by either:
1. Kidney damage, with or without decreased
GFR, as defined by
○ pathologic abnormalities
○ markers of kidney damage, including abnormalities
in the composition of the blood or urine or
abnormalities in imaging tests
2. GFR <60 ml/min/1.73 m2, with or without
kidney damage
Epidemiology And Staging of CKD
General 5-12 20 5
CRF NA 25-50 NA
HD 42 75 40
PD 40 75 40
Tx recipient 15 50 NA
Hypertension and Kidney
Nephron mass
Glomerular capillary hypertension
SYSTEMIC Glomerular permeability to macromolecules
HYPERTENSION Filtration of plasma proteins Proteinuria
Excessive tubular protein reabsorbtion
Tubulo-interstitial inflammation
RENAL SCARRING
Importance of Proteinuria in CKD
REASONS WHY ALBUMINURIA IS
RISK FACTOR FOR CVD
●Is assoc with high prevalence of traditional
risk factors
●May reflect generalised endothelial
dysfunction, increased vascular permeability
and abnormality of coagulation system
●May be assoc with markers of inflammation
●May indicate the severity of end organ
damage
SURVIVAL RATE IN ESRD AND
GENERAL POPULATION
Age-Standardized Rates of Death from Any Cause
(Panel A) and Cardiovascular Events (Panel B),
According to the Estimated GFR among 1,120,295
Ambulatory Adults
STOP IF
Eplerenone in CKD
●In a study with Type 2 diabetes+ HTN+
microalbuminuria, patients received either
Eplerenone, Enalapril, or combination
●After 24 weeks, the Eplerenone group had
a greater reduction in proteinuria (62% vs.
45%) and a 74% reduction in the
combination group but a higher incidence
of hyperkalemia
STOP IF
New Modalities for Hypertension
Therapy
●ACE-I-NEP inhibitors (vasopeptidase
inhibitors e.g Omapatrilat )
●Endothelin inhibitors (Darusentan)
●Direct renin Inhibitors (Aliskerin)
●Implantable carotid sinus nerve stimulators
Blood Pressure Is Poorly
Controlled In CKD