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Volume control and blood pressure management in patients undergoing quotidian hemodialysis

Am J Kidney Dis. 2003 Jul;42(1 Suppl):13-7
Volume control and blood pressure management in patients undergoing quotidian hemodialysis.
Nesrallah G, Suri R, Moist L, Kortas C, Lindsay RM.
Optimal Dialysis Research Unit, London Health Sciences Centre, London, Ontario, Canada

Background

Hypertension and interdialytic weight gain are associated with left ventricular hypertrophy (LVH), an important predictor of cardiovascular mortality in hemodialysis (HD) patients.

Methods

A group of patients receiving quotidian HD, either short daily (n = 11) or long nocturnal (n = 12), were followed for up to 18 months. Patients were assessed for effects of quotidian HD therapy on blood pressure, interdialytic weight gain, extracellular fluid volume (ECFV), intensity of antihypertensive therapy, and homocysteine levels.

Results

• Significant reductions in predialysis mean arterial blood pressure were observed in the daily HD group at 6 months (P < 0.04) and in the nocturnal HD group at 9 months (P < 0.03).
• The daily HD group had a 60% reduction in mean number of antihypertensive tablets per day at 1 month and an 8.8-fold reduction by 18 months.
• Nocturnal HD patients experienced a 3.3-fold reduction, and control patients, a 1.4-fold increase in mean number of tablets per day by 18 months.
• By 3 months, the daily HD group showed a significant decrease in interdialytic weight gain (P < 0.0005) and lower ECFV than controls (P < 0.05).
• Homocysteine levels were significantly lower for both quotidian HD groups compared with conventional HD patients.

Conclusion

• Both short daily hemodialysis and long nocturnal hemodialysis are therapies with potent antihypertensive effects, resulting not only in improved blood pressure control, but also in reduction in need for antihypertensive therapy, interdialytic weight gains, and homocysteine levels.

By improving blood pressure control and reducing interdialytic weight gains, 2 parameters shown to reduce LVH, quotidian hemodialysis may reduce cardiovascular morbidity and mortality.