Ambulatory blood pressure monitoring in patients receiving long, slow home haemodialysis

Background. Good blood pressure (BP) control has been reported previously in haemodialysis (HD) patients receiving 8-h dialysis sessions. Home HD allows patients to dialyse for long periods, but there are few data on the BP control achieved by these patients. We studied BP control, using ambulatory blood pressure monitoring (ABPM), in our home-HD patients who were receiving long-hours dialysis. Methods. Twenty-four patients aged 52.7+/-11 years underwent ABPM. They had been on home HD for 52.9+/-39 months and dialysed for 7.2+/-1.1 h thrice weekly. Two patients were taking antihypertensive drugs. Historical data on BP and weight gains were obtained from the patients' own records. Left ventricular (LV) mass was assessed by echocardiography and total body water (TBW) by bioelectrical impedance. Results, The mean 24-h BP was 129+/-17 mmHg (systolic) and 83+/-14 mmHg (diastolic). The daytime BP was 131+/-17 mmHg (systolic) and 84+/-14 mmHg (diastolic), while the night-time BP was 126+/-22 mmHg (systolic) and 81+/-17 mmHg (diastolic). Six patients (25%) had a normal circadian BP rhythm, but the rest showed a subnormal fall or an increase in BP at night. Mean 24-h BP did not correlate significantly with time on dialysis, dialysis session length, Kt/V, haemoglobin, interdialytic weight gain, or TBW. Twenty-one patients (87%) had LV hypertrophy and 16 of these had diastolic dysfunction. LV mass index was inversely correlated with nocturnal BP fall (r = -0.54, P = 0.03). Non-dippers had been treated longer than dippers (29 vs 59.2 months, P=0.03) but they were similar in respect to age, dialysis session length or Hb concentration. Conclusions, Long, slow haemodialysis at home provides satisfactory daytime BP control in the majority of patients without the need for antihypertensive drugs but abnormal circadian BP rhythm and LV hypertrophy remain common.