Equal levels of blood pressure control in ESRD patients receiving high- efficiency hemodialysis and conventional hemodialysis

Document Type

Journal Article

Publication Date

1-1-1998

Journal

American Journal of Kidney Diseases

Volume

31

Issue

4

DOI

10.1053/ajkd.1998.v31.pm9531177

Keywords

Blood pressure control; High-efficiency hemodialysis; High-flux hemodiafiltration; High-flux hemodialysis; Hypertension; Interdialytic weight gain; Treatment time

Abstract

The present study compared the status of hypertension and adequacy of blood pressure control in 73 end-stage renal disease (ESRD) patients treated with four different modalities of hemodialysis, namely, conventional hemodialysis (CHD) with cuprophan 1.1m2 at a blood flow rate of 300 mL/min, high-efficiency hemodialysis (HED) with cuprophan 1.6 m2 at a blood flow rate of 450 to 500 mL/min, high-flux hemodialysis (HFD) with F80 polysulfone 1.8 m2 at a blood flow rate 500 mL/min, and high-flux hemodiafiltration (HDF) with F80 2 x 1.8 m2 in series at a blood flow rate of 600 to 650 mL/min. Thirty of the 73 patients (41/%) were receiving one or more antihypertensive agents to control their hypertension. The percentage of patients taking antihypertensive medication was less in the groups treated with HED, HFD, and HDF compared with the CHD group; 38%, 39%, and 39%, respectively, in the HED, HFD, and HDF groups versue 56% in the CHD group. Control of systolic hypertension was achieved in a higher percentage of patients treated with HED, HFD, and HDF compared with patients treated with CHD. Sixty-two percent of HED, 58% of HFD, and 61% of HDF patients compared with 44% of CHD patients had systolic blood pressure less than 150 mm Hg, whereas 77% of HED, 76% of HFD, and 78% of HDF patients compared 56% of CHD patients had diastolic blood pressure less than 90 mm Hg. However, the differences in the use of antihypertensive medication and control rates of hypertension did not reach statistical significance. The average blood pressure of all patients was 144/89 mm Hg; this did not differ significantly between the four groups. There also were no significant differences is etilogy of ESRD, hematocrit, biochemical data, as well as use and dose of recombinant human erythropoletin between the four groups. Compare with the CHD patients, the average treatment times with high-efficiency treatments were shorter, with HDF patients showing the shortest mean treatment time of 157 ± 41 minutes per hemodialysis session. The mean Kt/V was higher in the groups treated with HED, HFD, or HDF (1.31 ± 03, 1.30 ± 0.4, and 1.43 ± 0.3, respectively) then in the CHD group (1.12 ± 0.3; P < 0.05). Interdialytic weight gain also did not differ among the four groups. There was no correlation between predialysis mean arterial pressure and either treatment time (r=0.04, P=NS), Kt/V (r = 0.03, P=NS), ultrafiltration rate (r=0.06, P=NS), or interdialytio weight gain (r= 0.08, P=NS). There also was no significant association between Kt/V and use of antihypertensive medications (chi-square = 1.76, P = NS). There was, however, a significant positive correlation between interdialytic weight gain and treatment time (r = 0.33, P < 0.01). We conclude that the use of short dialysis sessions with efficient hemodialysis treatments, namely, HFD and HDF, was associated with similar levels of blood pressure control in ESRD patients.

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