Long-Term Peridialytic Blood Pressure Patterns in Patients Treated by Hemodialysis and Hemodiafiltration.

Autor:	Rootjes PA; Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands., de Roij van Zuijdewijn CLM; Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands., Grooteman MPC; Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands., Bots ML; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands., Canaud B; Center of Excellence Medical, Fresenius Medical Care GmbH, Bad Homburg, Germany.; University of Montpellier, Research and Training Unit Medicine, Montpellier, France., Blankestijn PJ; Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands., van Ittersum FJ; Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands., Maduell F; Department of Nephrology, Hospital Clinic, Barcelona, Spain., Morena M; PhyMedExp, National Institute of Health and Medical Research, French National Centre for Scientific Research, University of Montpellier, Department of Biochemistry and Endocrinology, Central University Hospital Montpellier, Montpellier, France., Peters SAE; The George Institute for Global Health, University of Oxford, Oxford, UK., Davenport A; Royal Free Hospital, University College London Medical School, London, UK., Vernooij RWM; Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.; Department of Nephrology & Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands., Nubé MJ; Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Centers, VU University, Amsterdam, the Netherlands.
Jazyk:	angličtina
Zdroj:	Kidney international reports [Kidney Int Rep] 2020 Jan 31; Vol. 5 (4), pp. 503-510. Date of Electronic Publication: 2020 Jan 31 (Print Publication: 2020).
DOI:	10.1016/j.ekir.2020.01.007
Abstrakt:	Introduction: Online postdilution hemodiafiltration (HDF) is associated with a lower all-cause and cardiovascular mortality than hemodialysis (HD). This may depend on a superior peridialytic (pre- and postdialysis, and the difference between these 2 parameters) hemodynamic profile. Methods: In this retrospective cohort analysis of individual participant data (IPD) from 3 randomized controlled trials (RCTs) ( n  = 2011), the effect of HDF and HD on 2-year peridialytic blood pressure (BP) patterns was assessed. Long-term peridialytic systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), and pulse pressure (PP), as well as the deltas (post- minus predialytic) were assessed in the total group of patients. Thereafter, these variables were compared between patients on HD and HDF, and in the latter group between quartiles of convection volume. Results: Mean pre- and postdialysis SBP, DBP, and MAP declined significantly during follow-up (predialytic: SBP -2.16 mm Hg, DBP -2.88 mm Hg, MAP -2.64 mm Hg), PP increased (predialytic 0.96 mm Hg). Peridialytic deltas remained unaltered. Differences between the 2 modalities, or between quartiles of convection volume were not observed. BP changes were independent of various baseline characteristics, including the decline in body weight over time. Conclusion: We speculate that the combination of a decreasing SBP and an increasing PP may be the clinical sequelae of a worsening cardiovascular system. Because especially HDF with a high convection volume has been associated with a beneficial effect on survival, our study does not support the view that superior peridialytic BP control contributes to this effect. (© 2020 International Society of Nephrology. Published by Elsevier Inc.)
Databáze:	MEDLINE
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