Fluid state and blood pressure control in patients treated with long and short haemodialysis

Katzarski, Krassimir; Charra, Bernard; Luik, A. J.; Nisell, J.; Filho, José C. Divino; Leypoldt, John K.; Leunissen, Karel M.L.; Laurent, Guy; Bergström, Jonas

doi:10.1093/ndt/14.2.369

Cited by 180 publications

(121 citation statements)

References 3 publications

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“…124 Normotension can be achieved independently of the duration of dialysis if the control of volume is adequate. 125 In fact, left ventricular mass index was also improved to a comparable degree in DRIP trial participants, in which the duration of dialysis was not altered but the dry weight was challenged. 126 …”

Section: Frequent Dialysis and Its Effect On Bpmentioning

confidence: 95%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

146

150

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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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Section: Frequent Dialysis and Its Effect On Bpmentioning

confidence: 95%

Assessment and Management of Hypertension in Patients on Dialysis

Agarwal

Flynn

Pogue

et al. 2014

Journal of the American Society of Nephrology

146

150

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“…The main reason for hypertension in dialysis patients is volume overload. [1][2][3] Haemodialysis is an intermittent type of renal replacement treatment, whereas patients with continuous ambulatory peritoneal dialysis (CAPD) have steady-state volume condition. Increased dietary Na intake, overestimation of the patient's dry weight and inadequate ultrafiltration by the peritoneum have been implicated for volume overload in dialysis patients.…”

Section: Introductionmentioning

confidence: 99%

Ambulatory blood pressure monitoring in haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients

et al. 2002

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The aim of this study was to compare the results of the 44-h ambulatory blood pressure monitoring (ABPM) data between haemodialysis (HDp) and CAPD patients and to investigate the relation of circadian rhythm in blood pressure (BP) with development of left ventricular hypertrophy. Twenty-two HDp (11 male, 11 female, mean age: 50 ± 17 years) and 24 CAPDp (11 male, 13 female, mean age: 47 ± 15 years) were included. Echocardiographic measurements and ABPM were performed in all study groups. ABPM of the first and second days were analysed separately and compared with CAPDp. Left ventricular hypertrophy was detected in 17 of the 22 HDp (77%) and 17 of the 24 CAPDp (71%). There was no significant differences between HD and CAPDp in respect to 44-h, daytime and night-time systolic and diastolic BP values. Although the course of BP in CAPDp was stable during the 44-h period, systolic and diastolic BP levels on the second day were significantly higher than those of on the first day in HDp (P Ͻ 0.001

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“…Several studies [5,6] confirmed the importance of total sodium and fluid removal in predicting survival of peritoneal dialysis patients. Indeed, peritoneal dialysis patients who had a history of volume overload were noted to have more severe cardiac hypertrophy and dilatation as well as worse systolic and diastolic function.…”

Section: Residual Renal Function In Relation To Volume Controlmentioning

confidence: 95%

Interests of Residual Renal Function in Peritoneal Dialysis

Aicha¹,

Mrabet²,

Guedri³

et al. 2017

J Nephrol Ther

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Background: Decline of Residual renal function (RRF) is commonly observed in dialysis patients. RRF may play a significant role in the treatment adequacy and outcomes of dialysis patients. Several prospective observational and interventional studies have shown that the presence of RRF was associated with an improved outcome and a reduced mortality in dialysis patients. Preserving RRF is an old holistic dream that still remains to date a source of debate among the nephrologists.

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Fluid state and blood pressure control in patients treated with long and short haemodialysis

Cited by 180 publications

References 3 publications

Assessment and Management of Hypertension in Patients on Dialysis

Assessment and Management of Hypertension in Patients on Dialysis

Ambulatory blood pressure monitoring in haemodialysis and continuous ambulatory peritoneal dialysis (CAPD) patients

Interests of Residual Renal Function in Peritoneal Dialysis

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