Physiological Mechanisms of Hypertension and Cardiovascular Disease in End-Stage Kidney Disease

Purpose of Review: In this article, we summarize recent advances in understanding hypertension and cardiovascular disease in patients with end-stage kidney disease. Recent Findings: Factors such as anemia, valvular and vascular calcification, vasoconstrictors, uremic toxins, hypoglycemia, carbamylated proteins, oxidative stress, and inflammation have all been associated with the progression of cardiovascular disease in end-stage kidney disease but the causality of these mechanisms has not been proven. Summary: The high risk of cardiovascular mortality hasnot improved as in the general population despite many advancements incardiovascular care over the last two decades. Mechanisms that increasehypertension risk in these patients are centered on the control of extracellularfluid volume; however, over-correction of volume with dialysis can increase risksof intradialytic hypotension and death in these patients. This review presentsboth recent and classic work that increases our understanding of hypertensionand cardiovascular disease in end-stage kidney disease.