Short daily hemodialysis: blood pressure control and left ventricular mass reduction in hypertensive hemodialysis patients
| Autor: | Giovanni Ciao, Umberto Buoncristiani, Giuseppe Quintaliani, Jean Marie Kaufman, Gianpaolo Reboldi, Franca Pasticci, Paolo Pasini, Beatrice Cicconi, Riccardo Maria Fagugli |
|---|---|
| Rok vydání: | 2001 |
| Předmět: |
medicine.medical_specialty
Randomization Ambulatory blood pressure Hypertension Renal Heart disease medicine.medical_treatment Diastole Blood Pressure Body Water Renal Dialysis Internal medicine medicine Humans Prospective cohort study Cross-Over Studies business.industry Blood Pressure Monitoring Ambulatory medicine.disease Crossover study Surgery Blood pressure Nephrology Echocardiography Cardiology Kidney Failure Chronic Hypertrophy Left Ventricular Hemodialysis business |
| Zdroj: | American journal of kidney diseases : the official journal of the National Kidney Foundation. 38(2) |
| ISSN: | 1523-6838 |
| Popis: | Several retrospective and uncontrolled prospective studies reported blood pressure (BP) normalization and left ventricular mass (LVM) reduction during daily hemodialysis (DHD). Conversely, the burden of these major independent risk factors is only marginally reduced by the initiation of standard thrice-weekly dialysis (SHD), and cardiovascular events still represent the most common cause of death in hemodialysis patients. Therefore, we performed a randomized two-period crossover study to compare the effect of short DHD versus SHD on BP and LVM in hypertensive patients with end-stage renal disease. We studied 12 hypertensive patients who had been stable on SHD treatment for more than 6 months. At the end of 6 months of SHD and 6 months of DHD in a sequence of randomly assigned 24-hour ambulatory BP monitoring, echocardiography and bioimpedance were performed. Throughout the study, patients maintained the same Kt/V. A significant reduction in 24-hour BP during DHD was reported (systolic BP [lsqb ]SBP[rsqb ]: DHD, 128 [plusmn] 11.6 mm Hg; SHD, 148 [plusmn] 19.2 mm Hg; P [lt ] 0.01; diastolic BP: DHD, 67 [plusmn] 8.3mm Hg; SHD, 73 [plusmn] 5.4 mm Hg; P [equals] 0.01). The decrease in BP was accompanied by the withdrawal of antihypertensive therapy in 7 of 8 patients during DHD (P [lt ] 0.01). LVM index (LVMI) decreased significantly during DHD (DHD, 120.1 [plusmn] 60.4 g/m2; SHD, 148.7 [plusmn] 59.7 g/m2; P [equals] 0.01). Extracellular water (ECW) content decreased from 52.7% [plusmn] 11.4% to 47.6% [plusmn] 7.5% (P [equals] 0.02) and correlated with 24-hour SBP (r [equals] 0.63; P [lt ] 0.01) and LVMI (r [equals] 0.66; P [lt ] 0.01). In conclusion, this prospective crossover study confirms that DHD allows optimal control of BP, reduction in LVMI, and withdrawal of antihypertensive treatment. These effects seem to be related to reduction in ECW content. [copy ] 2001 by the National Kidney Foundation, Inc. |
| Databáze: | OpenAIRE |
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