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More recent definitions have also linked HHD to LVH. Frohlich et al defined HHD as the cardiac response to the afterload imposed on the left ventricle by the progressive increase in arterial pressure and peripheral vascular resistance as a consequence of hypertensive vascular disease20. Insummary, a patient with high blood pressure can be defined with this staging classification of HHD as V(0-3) I(0-3) A(0-3). Over 1.1 billion people worldwide, one-fourth of all men and one-fifth of all women suffer from hypertension and the condition is in control in less than 20% of the affected population. It is also the main risk factor and cause of hypertensive heart disease 1. Associations If hemodialysis patients currently treating three days per week are experiencing large fluid gains, impaired cardiovascular function, hemodynamic instability, or are otherwise not tolerating their current therapy, they may want to consider more frequent hemodialysis. More frequent home hemodialysis is associated with: Significant Cardiovascular Benefits:

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U.S. Renal Data System, USRDS 2015 Annual Data Report: Table 6.3. Adjusted survival (%) by (a) treatment modality and incident cohort year (year of ESRD onset), and (b) age, sex, race, and primary cause of ESRD, for ESRD patients in the 2008 incident cohort (initiating ESRD treatment in 2008) Abbreviation: ESRD, end-stage renal disease.Chest x-ray might show an enlargement of the cardiac silhouette or cardiothoracic ratio. Echocardiography Mavrogeni S, Katsi V, Vartela V et al. The Emerging Role of Cardiovascular Magnetic Resonance in the Evaluation of Hypertensive Heart Disease. BMC Cardiovasc Disord. 2017;17(1):132. doi:10.1186/s12872-017-0556-8 - Pubmed More than 15% of HHD patients are already safely performing their treatments without a care partner Heidenheim PA, Muirhead N, Moist L, Lindsay RM. Patient quality of life on quotidian hemodialysis. Am J Kidney Dis. 2003;42(S1)(S1):S36-S41.

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Another part of the management includes lifestyle modifications and the control of other cardiovascular risk factors. Differential diagnosis A qualified patient may dialyze alone, without a care partner present (solo home hemodialysis), provided the patient and physician agree that solo home hemodialysis is appropriate. Certain risks associated with hemodialysis treatment are increased when performing solo home hemodialysis because no one is present to help the patient respond to health emergencies. If patients experience needles coming out, blood loss, or very low blood pressure during solo home hemodialysis, they may lose consciousness or become physically unable to correct the health emergency. Losing consciousness or otherwise becoming impaired during any health emergency while alone could result in significant injury or death. Additional ancillary devices and training are required when performing solo home hemodialysis. Weinhandl ED, Lie J, Gilbertson DT, Arneson TJ, Collins AJ. Survival in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. J Am Soc Nephrol. 2012;23(5):895-904.Despite a number of studies performed over the years, no comprehensive definition and no clinically meaningful classification of hypertensive heart disease (HHD) is available. That is why the Steering Committee of the Hypertension Working Group of the Spanish Society of Cardiology developed a clinical classification of the so called “hypertensive cardiopathy” based on the three main heart components involved in patients with chronic elevated blood pressure8. This classification is briefly reviewed next. 3- The basis for a clinical classification of hypertensive heart disease Bhatt DL, Steg PG, Ohman EM, Hirsch AT, Ikeda Y, Mas JL, et al; the REACH Registry Investigators. International prevalence, recognition, and treatment of cardiovascular risk factors in outpatients with atherothrombosis. JAMA 2006;295:180-9. Maak een einde aan de kosten en complexiteit van het opslaan, verplaatsen en activeren van gegevens op schaal.

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Pauly RP, Gill JS, Rose CL, et al. Survival among nocturnal home haemodialysis patients compared to kidney transplant recipients. Nephrol Dial Transplant. 2009;24:2915-2919. Nordin S, Dancy L, Moon J, Sado D. Clinical Applications of Multiparametric CMR in Left Ventricular Hypertrophy. Int J Cardiovasc Imaging. 2018;34(4):577-85. doi:10.1007/s10554-018-1320-6 - PubmedTin LL, Beevers DG, Lip GY. Hypertension, left ventricular hypertrophy, and sudden death. Curr Cardiol Rep 2002;4:449-57. Weinhandl ED, Nieman KM, Gilbertson DT, Collins AJ. Hospitalization in daily home hemodialysis and matched thrice-weekly in-center hemodialysis patients. Am J Kidney Dis. 2015;65(1):98-108.