Ultrafiltration intensification in hemodialysis patients improves hypertension but increases AV fistula complications and cardiovascular events

被引:33
作者
Curatola, Giuseppe
Bolignano, Davide
Rastelli, Stefania
Caridi, Graziella
Tripepi, Rocco
Tripepi, Giovanni
Politi, Raffaele
Catalano, Francesco
Delfino, Diego
Ciccarelli, Maurizio
Mallamaci, Francesca
Zoccali, Carmine
机构
[1] United Hosp, Nephrol Dialysis & Renal Transplantat Unit, Reggio Di Calabria, Italy
[2] United Hosp, CNR IBIM Clin Epidemiol & Pathophysiol Renal Dis, Reggio Di Calabria, Italy
关键词
Dialysis; Hemodialysis; Hypertension; Ultrafiltration; Volume expansion; BLOOD-PRESSURE; DIALYSIS PATIENTS; PREDIALYSIS; REGRESSION; ADHERENCE; SUPPORT;
D O I
10.5301/JN.2011.7735
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Introduction: Hypertension remains a major problem in hemodialysis (HD) patients. Methods: We performed a pragmatic trial (Pragmatic Clinical Intervention on Blood Pressure Driven by Audit [CLINIDEA]) testing the effectiveness and safety of a 6-month multimodal intervention in hypertensive HD patients regarding the application of higher ultrafiltration (UF) rates or longer or more frequent dialyses in UF-intolerant patients, and an educational intervention to encourage patients to lower their salt and fluid intake. Results: Blood pressure (BP) in hypertensive patients (n=32) fell from 156.8 +/- 13.3 / 81.1 +/- 8.9 mm Hg to 147.9 +/- 18.8 / 77.5 +/- 11.1 mm Hg. UF intensification was well tolerated, and the BP goal was achieved without resorting to longer or more frequent dialyses. BP changes were paralleled by a consistent (p<0.01) fall in dry body weight. The trial largely failed at increasing compliance with salt prescription (salt intake: baseline: 156.9 +/- 64 mEq/day, 6-month: 150.7 +/- 60.3 mEq/day). During the 12 months preceding the trial, the hospitalization rates for arteriovenous (AV) fistula complications and cardiovascular (CV) events were identical in hypertensive and in normotensive patients. However, these complications selectively increased (AV complications: relative risk [RR] = 7.6; CV complication: RR=8.4) in hypertensive patients coinciding with UF intensification during the trial. Increasing the UF rate is an effective BP-lowering intervention in HD patients. However, this intervention is associated with a higher risk for AV complications and CV events. Conclusion: Longer and/or more frequent dialyses and better efforts to increase compliance to low salt diets than those put in place in this study are needed to reduce the high prevalence of hypertension in the HD population.
引用
收藏
页码:465 / 473
页数:9
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