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Therapy of resistant hypertension in patients with chronic kidney disease complications of anemia in hemodialysis: a case report

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Chronic Kidney Disease (CKD) is closely related to hypertension. Increasing the severity of CKD is associated with more difficult blood pressure control. Appropriate therapeutic management is needed to prevent complications due to uncontrolled hypertension. We report the case of a 78-year-old female patient with a diagnosis of hypertension and end-stage CKD with a history of undergoing hemodialysis for 4 years. The patient has been taking antihypertensive drugs such as Angiotensin Receptor Blockers, Calcium Channel Blockers and Diuretics. However, the administration of three antihypertensive drugs still could not help achieve the expected blood pressure target where the systolic blood pressure was still above 160 mmHg. The patient also has anemia as a common complication of chronic kidney disease. Appropriate management of therapy with fourth-line therapy and hemoglobin repair is necessary to achieve improved clinical outcomes and reduce renal worsening.

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  • Agarwal, R., Flynn, J., Pogue, V., Rahman, M., Reisin, E., & Weir, M. R. (2014). Assessment and management of hypertension in patients on dialysis. Journal of the American Society of Nephrology : JASN, 25(8), 1630–1646. https://doi.org/10.1681/ASN.2013060601
  • Ameer O. Z. (2022). Hypertension in chronic kidney disease: What lies behind the scene. Frontiers in pharmacology, 13, 949260. https://doi.org/10.3389/fphar.2022.949260
  • Ammirati A. L. (2020). Chronic Kidney Disease. Revista da Associacao Medica Brasileira (1992), 66Suppl 1(Suppl 1), s03–s09. https://doi.org/10.1590/1806-9282.66.S1.3
  • Anna Forbes, Hugh Gallagher. Clinical Medicine Mar 2020, 20 (2) 128-132; DOI: 10.7861/clinmed.cg.20.2
  • Basile, D. P., Anderson, M. D., & Sutton, T. A. (2012). Pathophysiology of acute kidney injury. Comprehensive Physiology, 2(2), 1303–1353. https://doi.org/10.1002/cphy.c110041
  • Carey R. M., Calhoun, D. A., Bakris, G. L., Brook, R. D., Daugherty, S. L., Dennison-Himmelfarb, C. R., Egan, B. M., Flack, J. M., Gidding, S. S., Judd, E., Lackland, D. T., Laffer, C. L., Newton-Cheh, C., Smith, S. M., Taler, S. J., Textor, S. C., Turan, T. N., & White, W. B. (2018). Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension, 72(5). https://doi.org/10.1161/HYP.0000000000000084
  • Chen, T. K., Knicely, D. H., & Grams, M. E. (2019). Chronic Kidney Disease Diagnosis and Management: A Review. JAMA, 322(13), 1294–1304. https://doi.org/10.1001/jama.2019.14745
  • Delacroix, S., & Chokka, R. G. (2014). Hypertension: Pathophysiology and Treatment. Journal of Neurology & Neurophysiology, 05(06). https://doi.org/10.4172/2155-9562.1000250
  • Delong C, Sharma S. Physiology, Peripheral Vascular Resistance. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538308/
  • Doumas, M., Imprialos, K. P., Kallistratos, M. S., & Manolis, A. J. (2020). Recent advances in understanding and managing resistant/refractory hypertension. F1000Research, 9, 169. https://doi.org/10.12688/f1000research.21669.1
  • Fay, K. S., & Cohen, D. L. (2021). Resistant Hypertension in People With CKD: A Review. American Journal of Kidney Diseases, 77(1), 110-121. https://doi.org/10.1053/j.ajkd.2020.04.017
  • Hamrahian, S. M., & Falkner, B. (2016). Hypertension in Chronic Kidney Disease (pp. 307-325). https://doi.org/10.1007/5584_2016_84
  • Irawan, A. (2014). Increase of Serum Creatinine as the Outcome of ACEi or ARB Use. Indonesian Journal of Clinical Pharmacy, 3(3), 82-87. https://doi.org/10.15416/ijcp.2014.3.3.82
  • James, P. A., Oparil, S., Carter, B. L., Cushman, W. C., Dennison-Himmelfarb, C., Handler, J., Lackland, D. T., LeFevre, M. L., MacKenzie, T. D., Ogedegbe, O., Smith, S. C., Svetkey, L. P., Taler, S. J., Townsend, R. R., Wright, J. T., Narva, A. S., & Ortiz, E. (2014). 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults. JAMA, 311(5), 507. https://doi.org/10.1001/jama.2013.284427
  • KDIGO, 2013. https://kdigo.org/guidelines/ckd-evaluation-and-management
  • Khan, Y. H., Sarriff, A., Adnan, A. S., Khan, A. H., & Mallhi, T. H. (2016). Chronic Kidney Disease, Fluid Overload and Diuretics: A Complicated Triangle. PloS one, 11(7), e0159335. https://doi.org/10.1371/journal.pone.0159335
  • Kim, C. S., Choi, H. S., Bae, E. H., Kim, S. W., & Ma, S. K. (2019). Optimal blood pressure target and measurement in patients with chronic kidney disease. The Korean Journal of Internal Medicine, 34(6), 1181-1187. https://doi.org/10.3904/kjim.2019.164
  • Ku, E., Lee, B. J., Wei, J., & Weir, M. R. (2019). Hypertension in CKD: Core Curriculum 2019. American Journal of Kidney Diseases, 74(1), 120-131. https://doi.org/10.1053/j.ajkd.2018.12.044
  • Murdeshwar HN, Anjum F. Hemodialysis. [Updated 2023 Apr 27]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK563296/
  • Oh, S. W., & Han, S. Y. (2015). Loop Diuretics in Clinical Practice. Electrolyte & blood pressure : E & BP, 13(1), 17–21. https://doi.org/10.5049/EBP.2015.13.1.17
  • Pugh, D., Gallacher, P. J., & Dhaun, N. (2019). Management of Hypertension in Chronic Kidney Disease. Drugs, 79(4), 365–379. https://doi.org/10.1007/s40265-019-1064-1
  • Rabbani, R., Noel, E., Boyle, S., Balina, H., Ali, S., Fayoda, B., & Khan, W. A. (2022). Role of Antihypertensives in End-Stage Renal Disease: A Systematic Review. Cureus, 14(7), e27058. https://doi.org/10.7759/cureus.27058
  • Stern, A., Sachdeva, S., Kapoor, R., Singh, J., & Sachdeva, S. (2014). High Blood Pressure in Dialysis Patients: Cause, Pathophysiology, Influence on Morbidity, Mortality and Management. JOURNAL OF CLINICAL AND DIAGNOSTIC RESEARCH. https://doi.org/10.7860/JCDR/2014/8253.4471
  • Tobe, S. W., & Lewanczuk, R. (2009). Resistant hypertension. The Canadian journal of cardiology, 25(5), 315–317. https://doi.org/10.1016/s0828-282x(09)70496-9
  • Trammel JE, Sapra A. Physiology, Systemic Vascular Resistance. [Updated 2023 Jul 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556075/
  • van Buren, P. N. (2016). Evaluation and Treatment of Hypertension in End-Stage Renal Disease Patients on Hemodialysis. Current Cardiology Reports, 18(12), 125. https://doi.org/10.1007/s11886-016-0805-y
  • Williams, B., MacDonald, T. M., Morant, S., Webb, D. J., Sever, P., McInnes, G., Ford, I., Cruickshank, J. K., Caulfield, M. J., Salsbury, J., Mackenzie, I., Padmanabhan, S., & Brown, M. J. (2015). Spironolactone versus placebo, bisoprolol, and doxazosin to determine the optimal treatment for drug-resistant hypertension (PATHWAY-2): a randomised, double-blind, crossover trial. The Lancet, 386(10008), 2059-2068. https://doi.org/10.1016/S0140-6736(15)00257-3
  • Williams, B., Mancia, G., Spiering, W., Agabiti Rosei, E., Azizi, M., Burnier, M., Clement, D. L., Coca, A., de Simone, G., Dominiczak, A., Kahan, T., Mahfoud, F., Redon, J., Ruilope, L., Zanchetti, A., Kerins, M., Kjeldsen, S. E., Kreutz, R., Laurent, S., ‚Ķ Brady, A. (2018). 2018 ESC/ESH Guidelines for the man
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How to Cite This

Sumarlim, Y., Gan, E., Wuryana, D., Pristantiningtyas, M. H., Dharma, H. P., Muchlis, M., Pratama, J. E., Setiadi, A. P., & Gondokesumo, M. E. (2023). Therapy of resistant hypertension in patients with chronic kidney disease complications of anemia in hemodialysis: a case report. Jurnal Teknologi Laboratorium, 12(2). Retrieved from https://www.teknolabjournal.com/index.php/Jtl/article/view/444

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