Potential for Managing Hypertension in Chronic Kidney Disease

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Journal of Clinical Nephrology and Therapeutics is a peer-reviewed scientific open access journal that publishes manuscripts on diagnosis and management of kidney diseases and associated disorders.

The dietary approaches to stop hypertension (DASH) diet. Hypertension is highly prevalent in Chronic Kidney Disease (CKD) and is implicated in renal disease progression. Hypertension is also a major risk factor for Cardiovascular Disease (CVD), the main cause of premature death in the CKD population. Strategies which support management of hypertension are therefore fundamental to effective CKD management. Evidence based guidance on the management of hypertension in CKD focuses on medical and pharmacological approaches, but also highlights the importance of diet and lifestyle modification. The Dietary Approaches to Stop Hypertension (DASH) diet promotes an eating pattern based on an increased intake of fruit, vegetables, nuts, seeds, whole grains, fish and dairy produce and decreased intake of sodium. The DASH diet reduces blood pressure in free living adults with normal renal function. In CKD the use of a low sodium diet may augment the efficacy of antihypertensive and anti-proteinuric medications. The evidence base for the DASH diet in populations with normal renal function, when used as initial management or as an adjunct to medication, supports consideration of its use to optimise hypertension management in CKD. Indeed, the DASH diet is advocated by The National Kidney Foundation–Kidney Disease Outcomes Quality Initiative (NKF-KDOQI), alongside other lifestyle modifications, as initial treatment for less severe stages of hypertension in the general population. However individuals with renal insufficiency were excluded from the original DASH studies and an increase in the intake of some of the nutrients advocated by the diet could result in dietary potassium, phosphate and protein contents that exceed those recommended for people with CKD.

This commentary suggests that the DASH diet is safe for use in nondiabetic subjects with stage 3 CKD even when antihypertensive medication that blocks the angiotensinaldosterone system is prescribed. The only significant side effects appeared to relate to reduction in blood pressure, which could be appropriately managed by reduction in prescribed antihypertensive medication. The results of the study warrant consideration of a larger population based trial which includes patients with diabetes.

Best Regards,
Anna Melissa
Editorial Manager
Journal of Clinical Nephrology and Therapeutics