Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP)

Agarwal, Rajiv; Alborzi, Pooneh; Satyan, Sangeetha; Light, Robert P.

doi:10.1161/hypertensionaha.108.125674

Cited by 325 publications

(329 citation statements)

References 32 publications

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“…Left ventricular morphology itself is heavily affected by preload condition; in particular, HD significantly reduced LV hypertrophy prevalence in our population (42% vs 24%) as well as in other studied groups [2]. This change, as recently clearly pointed out [18], is mainly due to a reduction in end-diastolic diameter, as no difference in infero-lateral wall thickness was revealed in our population.…”

Section: Dehydration During Hd Led To Reduction Of All Main Clinical supporting

confidence: 65%

“…Chronic volume overload in ESRD has since time been recognized as the main responsible of hypertension development, with its detrimental role in increasing incidence of cardiovascular disease [1,2]. Moreover, HD-induced volume depletion is related to intradialityc hypotension [3], an independent risk factor for fatal events in ESRD population [4].…”

Section: Introductionmentioning

confidence: 99%

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Non Invasive Evaluation of Cardiac Hemodynamics in End Stage Renal Disease (ESRD)

Milan

Avenatti

Valle

et al. 2014

High Blood Press Cardiovasc Prev

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Objective: Volume overload is typical of haemodialysis patients; correct volume status evaluation is crucial in achieving blood pressure homeostasis, hypertension management and good treatment planning. This study evaluates the effect of acute volume depletion on ultrasonographic parameters and suggests two of them as able to predict patients volume overload. and LV end-diastolic diameter (LVEDd) indexed to height 2.7(LVEDdi) were able to predict volume overload: cut off values of respectively 13.5 mm/m 2.7 for LVEDdi and 173 cJ for SW were able to predict with a specificity of 100% the presence of a volemic overload of at least 4%. Patients and InterventionConclusions: Blood pressure, cardiac morphology and function are significantly modified by acute volume depletion and such variations are strictly interrelated. SW and LVEDd/height 2.7 may identify ESRD patients carrying an higher volume load.

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Section: Dehydration During Hd Led To Reduction Of All Main Clinical supporting

confidence: 65%

Section: Introductionmentioning

confidence: 99%

Non Invasive Evaluation of Cardiac Hemodynamics in End Stage Renal Disease (ESRD)

Milan

Avenatti

Valle

et al. 2014

High Blood Press Cardiovasc Prev

View full text Add to dashboard Cite

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“…Dry weight was reduced progressively in the randomized Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP) trial, as discussed below. 77 Those patients with intradialytic hypertension who had additional ultrafiltration and therefore a reduction in dry weight had improvement in both intradialytic and interdialytic hypertension. 74 This suggests that an appropriate therapy for this condition would be to further lower dry weight.…”

Section: Diagnosismentioning

confidence: 99%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

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156

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Hypertension is common, difficult to diagnose, and poorly controlled among patients with ESRD. However, controversy surrounds the diagnosis and treatment of hypertension. Here, we describe the diagnosis, epidemiology, and management of hypertension in dialysis patients, and examine the data sparking debate over appropriate methods for diagnosing and treating hypertension. Furthermore, we consider the issues uniquely related to hypertension in pediatric dialysis patients. Future clinical trials designed to clarify the controversial results discussed here should lead to the implementation of diagnostic and therapeutic techniques that improve long-term cardiovascular outcomes in patients with ESRD. Hypertension is common among patients with ESRD. In this review, we discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients. We also review areas of existing controversies and briefly discuss the issue of hypertension in pediatric dialysis patients. EPIDEMIOLOGYThe prevalence, treatment, and control of hypertension among people on hemodialysis (HD) have used varying definitions to diagnose hypertension. The epidemiology differs based on how BP is measured: either before and after dialysis or using ambulatory BP recordings. Epidemiology with Routine BP MeasurementsThe prevalence of hypertension (defined as 1-week average predialysis systolic BP [SBP] measurements .150 mmHg or diastolic BP [DBP].85 mmHg or the use of antihypertensive medications) was 86% among 2535 clinically stable adult HD patients participating in a multicenter trial. 1 Among hypertensive patients, 12% did not receive antihypertensive drugs, 58% were treated but not controlled, and only 30% were controlled. The use of antihypertensive drugs has been reported to vary from 59% to 83%. [2][3][4][5] Furthermore, even among children on long-term HD, similar findings have been reported. 6 Several studies have confirmed greater antihypertensive drug use to be associated with poorer control. 7,8 It should be noted that antihypertensive drug use per se do not lead to worse BP control; in the absence of adequate volume control, increasing antihypertensive drug use may simply reflect difficult-to-control BP. Epidemiology Using Ambulatory BP MeasurementsThe prevalence of hypertension (defined by either a 44-hour interdialytic ambulatory BP of $135/85 mmHg or the prescription of any antihypertensive agent) was 86% among 369 chronic HD patients. 8 Although hypertension was being treated with antihypertensive drugs in 89% of patients, it was adequately controlled only in 38%. The independent determinants of poor control were the use of antihypertensive drugs and an expanded extracellular volume state. If patients were volume overloaded, nearly 80% became hypertensive when medications were Published online ahead of print. Publication date available at www.jasn.org.

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“…This in turn implies that the longer a patient stays on dialysis, the more irreversible or intractable the systolic dysfunction becomes and a less dramatic improvement may occur after transplant. Another recent study by Agarwal et al (12) suggests that there is great benefit on BP and overall heart performance if patients have dry weight reduced by as little as 1 kg. This paper suggests that this can be done safely under careful circumstances.…”

Section: Therapeutic Strategiesmentioning

confidence: 99%

Optimal Cardiovascular Therapy for Patients with ESRD over the Next Several Years

Henrich

2009

Clinical Journal of the American Society of Nephrology

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This review points out the high morbidity and mortality associated with cardiovascular disease in patients with ESRD. Although there have been few randomized controlled trials that have examined this clinical problem in the population of patients with ESRD, there is a growing appreciation of the presentations and consequences of cardiovascular disease in this cohort. The etiology of this disease is multifactorial and the consequences include sudden death, coronary artery disease, and heart failure. The sudden death associated with ESRD has been linked to a progressive cardiac fibrosis that also accompanies left ventricular hypertrophy. Ischemic coronary disease is also common in this population.With regard to new therapy, efforts to control extracellular fluid volume and thereby control blood pressure are important. Two randomized trials have not shown the benefit of lowering low-density lipoprotein cholesterol concentrations in patients with ESRD, but such a strategy is thought to be beneficial in patients with chronic kidney disease. Efforts to optimally control calcium and phosphate concentrations are also beneficial, because vessel calcification remains a major problem for ESRD patients. The increase in vessel calcification leads to an increase in arterial stiffness and an increase in pulse wave velocity, which, in turn, increases cardiovascular morbidity and mortality.Additional recommendations are provided in this review including the use of erythrocyte stimulating agents, the cautious use of beta blockers with patients with a low ejection fraction systolic failure, and drugs that block the renin-angiotensinalderosterone system.Clin J Am Soc Nephrol 4: S106 -S109, 2009. doi: 10.2215/CJN.04640709 T he increased frequency of cardiovascular death among patients with chronic kidney disease (CKD) has been emphasized in many recent publications (1). This increase in cardiovascular morbidity and mortality is true for subcategories of cardiovascular disease including congestive heart failure, stroke, myocardial infarction, and composite death rates from cardiovascular causes (1). One problem that has limited progress in this field has been the fact that there has been a paucity of well designed randomized controlled trials that address the issue of which drugs or combinations of drugs are most effective in either reducing or slowing the growth of cardiovascular morbidity and mortality in ESRD and CKD patients. In fact, patients with CKD and ESRD have been routinely excluded from large trials of cardiovascular morbidity and mortality. This has resulted in a dearth of literature that speaks to evidence-based or best practice therapy in cardiovascular disease in patients with ESRD. Etiology and PresentationsThe etiology of cardiovascular disease in ESRD is multifactorial. As shown in Figure 1, there are several modifiable, nonmodifiable, and specific uremia-related factors that contribute to cardiovascular morbidity and mortality. As shown in the figure, all of these factors sum to increase arterial stiffness and inc...

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Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP)

Cited by 325 publications

References 32 publications

Non Invasive Evaluation of Cardiac Hemodynamics in End Stage Renal Disease (ESRD)

Non Invasive Evaluation of Cardiac Hemodynamics in End Stage Renal Disease (ESRD)

Assessment and Management of Hypertension in Patients on Dialysis

Optimal Cardiovascular Therapy for Patients with ESRD over the Next Several Years

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