Effects of hypervolemia on interdialytic hemodynamics and blood pressure control in hemodialysis patients

Luik, A. J.; Kuijk, Willi H M van; Spek, Janneke J.; Heer, Frederiek de; Bortel, L.M.A.B. Van; Schiffers, P. M. H.; Hooff, J. P. van; Leunissen, Karel M.L.

doi:10.1016/s0272-6386(97)90303-6

Cited by 46 publications

(39 citation statements)

References 30 publications

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“…Furthermore, the Pearson correlation analysis showed that both ECW and NECW were negatively correlated with TPRI (r = –0.541, p < 0.001, and r = –0.567, p < 0.01, respectively). These results indicated that a higher volume status tended to induce a decrease in TPRI, which was consistent with two previous studies performed by Huang et al [28] and Luik et al [29]. Huang et al [28] observed in a rat model that an increase in CI after opening an arteriovenous fistula resulted in a significant decrease in TPRI.…”

Section: Discussionsupporting

confidence: 92%

“…Huang et al [28] observed in a rat model that an increase in CI after opening an arteriovenous fistula resulted in a significant decrease in TPRI. Luik et al [29] investigated the influence of hypervolemia on hemodynamics and interdialytic BP as well as in relation to vascular compliance in 10 hemodialysis patients. Their study showed that intravascular volume and CO increased while the TPRI decreased following fluid load.…”

Section: Discussionmentioning

confidence: 99%

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Why Is There Significant Overlap in Volume Status between Hypertensive and Normotensive Patients on Dialysis?

Cheng

Tian²,

Tang³

et al. 2008

Am J Nephrol

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Background/Aim: Volume overload is believed to play a pivotal role in the pathogenesis of hypertension in dialysis patients. Although the extracellular water (ECW) content in hypertensive dialysis patients was significantly higher than in normotensive dialysis patients on the whole, there was considerable overlap in ECW between the two groups. Little is known about the hemodynamic characteristics in subgroups of patients with normotension but a high volume (HV) status or with hypertension but a normal volume (NV) status. We investigate the overlap in ECW between controlled and uncontrolled hypertension in dialysis patients. Methods: Fifty-two patients (mean age 62 years, 26 males and 26 females) on peritoneal dialysis were enrolled into this study. The ECW was assessed by bioimpedance analysis and normalized by individual height in meters (NECW). The mean value of NECW in both sexes was arbitrarily set to define NV status (lower than mean value) or HV status (higher than mean value). All patients were thus divided into four subgroups: controlled hypertension with NV (CHT-NV), controlled hypertension with HV (CHT-HV), uncontrolled hypertension with NV (UHT-NV) and uncontrolled hypertension with HV (UHT-HV). The stroke volume, cardiac output and total peripheral resistance were echocardiographically measured and their respective indices were calculated. Results: There were 12 (23%), 8 (15%), 14 (27%) and 18 (35%) patients in the CHT-NV, CHT-HV, UHT-NV and UHT-HV subgroups, respectively. The four subgroups were matched for sex, diabetes and age. The NECW in the CHT-HV group was higher than that in CHT-NV and UHT-NV groups (p < 0.01), but was comparable with that in the UHT-HV group. The stroke volume and cardiac output indices in the CHT-HV group were not significantly different from those in the CHT-NV and UHT-NV groups. The total peripheral resistance index in the CHT-HV group was lower than that in UHT-NV and CHT-NV groups (p < 0.05), but was comparable to that in the UHT-HV group. There was no difference in heart rate among the four groups. Conclusions: The overlap in ECW between controlled hypertension and uncontrolled hypertension in dialysis patients was related to a significant difference in total peripheral resistance index, but not to significant differences in stroke volume and cardiac output indices. The CHT-HV patients were characterized by lower total peripheral resistance indices.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Why Is There Significant Overlap in Volume Status between Hypertensive and Normotensive Patients on Dialysis?

Cheng

Tian²,

Tang³

et al. 2008

Am J Nephrol

View full text Add to dashboard Cite

show abstract

“…The same relationship was also not significant when we analyzed the blood pressure for the entire interdialytic period. Similarly, other investigators have failed to demonstrate a relationship between the increase in body weight and the interdialytic blood pressure profile [19, 20, 21, 22], even though it is well known that blood pressure management in hemodialysis is dependent on control of extracellular volume. One possible explanation in our patients is that many were using vasoactive drugs for hypertension treatment and it could have decreased vascular resistance, thereby minimizing the volume-dependent component of blood pressure.…”

Section: Discussionmentioning

confidence: 99%

“…However, in our series, even the patients who were not taking antihypertensive drugs did not have a significant correlation of the interdialytic blood pressure with the IDWG (data not shown). This may reflect individual differences of blood pressure response to the weight gain that may be dependent on various determinants of cardiac performance and vascular resistance [22]. Another possibility to explain this observation was raised by Sorof et al [23], who studied fluctuations in interdialytic BP in relationship to weight measured four times a day in patients in a clinical research center.…”

Section: Discussionmentioning

confidence: 99%

Profile of Interdialytic Blood Pressure in Hemodialysis Patients

Santos¹,

Mendes²,

Santos³

et al. 2003

Am J Nephrol

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Background and Methods: Hypertension is a common problem in hemodialysis (HD). However, its behavior during the interdialytic period is not completely known and is infrequently monitored in clinical practice. Thus, for better understanding of interdialytic blood pressure (BP), we analyzed the interdialytic blood pressure profile using 44-hour ambulatory blood pressure monitoring (ABPM) data in 71 unselected, stable HD patients. Results: There was an increase in BP during the interdialytic period (awake day 1: 135/84 ± 23/14 mm Hg; awake day 2: 140/86 ± 22/15 mm Hg, p < 0.05; sleep day 1: 130/77 ± 24/15 mm Hg; sleep day 2: 136/80 ± 24/15 mm Hg, p < 0.05). The correlation between the average 44-hour BP and interdialytic weight gain (IDWG) was not significant (r = –0.07 for systolic BP and r = –0.09 for diastolic BP). The number of non-dipper patients was high, 77% on interdialytic day 1 and 83% on interdialytic day 2 for systolic BP. Uncontrolled hypertension (average 44 h BP ≧135/85 mm Hg) was diagnosed in 58 (55%) patients. Patients with uncontrolled hypertension had higher pre- and posthemodialysis BP, higher BP on each interdialytic day and night, and higher night/day diastolic BP ratio on the second interdialytic day. These patients were also taking a greater number of vasoactive medications (1.5 vs. 0.6 in those with controlled BP, p = 0.001). There were no significant differences related to kt/V, hematocrit, or weekly erythropoietin dose between patients with controlled or uncontrolled BP. Hemodialysis shift assignment (morning or afternoon) did not impact on BP levels or diurnal profile. Conclusion: In HD patients, interdialytic BP is often poorly controlled, there is a progressive rise in BP, and a trend toward loss of nocturnal decline in BP as the interdialytic period progresses. Further research is needed to determine whether treatment directed to interdialytic BP changes can alter outcomes in HD patients.

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“…On the contrary, Testa et al 16 could not demonstrate an influence of volume overload on BP in PCHD. Luik et al 17 also concluded that interdialytic fluid load does not result in higher blood pressure in hemodialysis patients.…”

Section: Discussionmentioning

confidence: 98%