Blood pressure control with active ultrafiltration measures and without antihypertensives is essential for survival in hemodiafiltration and hemodialysis programs for patients with CKD. A prospective observational study.

Between 60% of hemodialysis patients have hypervolemia. The present study hypothesizes that there is more notable survival in CKD patients whose hypertension can be controlled without antihypertensives and with ongoing dry weight reduction with the point-of-care dry weight (POC-DW) technique.
Blood pressure control with active ultrafiltration measures and without antihypertensives is essential for survival in hemodiafiltration and hemodialysis programs for patients with CKD. A prospective observational study.
Like

Share this post

Choose a social network to share with, or copy the URL to share elsewhere

This is a representation of how your post may appear on social media. The actual post will vary between social networks

Explore the Research

BioMed Central
BioMed Central BioMed Central

Blood pressure control with active ultrafiltration measures and without antihypertensives is essential for survival in hemodiafiltration and hemodialysis programs for patients with CKD: a prospective observational study - BMC Nephrology

Background High blood pressure is a prevalent condition in patients with chronic kidney disease on hemodialysis. Adequate control of high blood pressure is essential to reducing deaths in this group. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point-of-care dry weight (POC-DW) technique. Methods The present observational, prospective study was carried out at the Pafram hemodiafiltration unit in Morona Santiago, Ecuador, and the hemodialysis unit of the Fundación Renal del Ecuador in Guayaquil, Ecuador, from August 2019 to December 2023. Patients who were receiving hemodiafiltration were included. Weight was optimized with POC-DW for eight weeks. In Group 1, patients whose use of antihypertensive drugs was not required to control systolic blood pressure with a value less than 150 mmHg predialysis, less than 130 mmHg postdialysis, and a peridialytic blood pressure (defined as post-HD minus pre-HD SBP) between 0 and − 20 mmHg were analyzed. In Group 2, patients who required antihypertensive drugs for not meeting the aims of systolic blood pressure were included. The variables included clinical, demographic, mortality, description of the treatment, and routine laboratory tests in dialysis programs. The sample was nonprobabilistic. Survival analysis was performed for the study groups. The log-rank test (Mantel-Cox) was used for survival comparisons. Results The study included 106 patients. Optimal blood pressure control without antihypertensive treatment was achieved in 52 patients (49.1%) (Group 1). In 54 patients (50.9%), antihypertensive agents were required (Group 2). There was more significant mortality in the group that received antihypertensives: 11 patients in group 1 (21.2%) versus 25 patients in group 2 (46.3%) (P = 0.005). Survival was more significant in group 1, with an HR of 2.2163 (1.125–4.158) (P = 0.0243). Conclusion In hemodiafiltration and hemodialysis programs, blood pressure control with active ultrafiltration measures and without using antihypertensives is essential for survival in patients with CKD.

The main finding confirms the hypothesis of the study that there is more remarkable survival in the group of patients with CKD whose hypertension can be controlled without antihypertensive treatment and with the use of constant dry weight reduction measures to optimize ultrafiltration. The factors associated with the lack of control of arterial hypertension were a history of vascular amputation, a history of being an ex-smoker, being a carrier of type 2 diabetes mellitus, having a serum ferritin level greater than 26.75%, being male, and being treated with hemodialysis. The associated protective factors were having a diagnosis of glomerulonephritis as an etiology of chronic kidney disease, a history of never smoking, a serum ALB concentration greater than 4.214 g/dl, effective blood flow greater than 423.5 ml/min, and interdialytic weight gain >4.925%, hemodiafiltration as treatment, urea levels less than 103.78 mg/dl, and fasting glucose levels less than 109.2 mg/dl. According to the time-adjusted model, only four factors were associated: age, transferrin saturation, serum albumin levels, and history of vascular amputation.

In the stratified analysis, differences in survival were demonstrated by the percentiles of blood pressure taken in the last month of survival or censoring. With blood pressures ranging from 141 mmHg to 122 mmHg, there is a proportional risk of death associated with the intake of antihypertensive agents. The same occurs when the blood pressure is less than 105 mmHg. These relationships could not be established with pressures greater than 141 mmHg.

Please sign in or register for FREE

If you are a registered user on Research Communities by Springer Nature, please sign in

Follow the Topic

Nephrology
Life Sciences > Health Sciences > Clinical Medicine > Nephrology
Haemodialysis
Life Sciences > Health Sciences > Clinical Medicine > Therapeutics > Renal replacement therapy > Haemodialysis
Mortality and Longevity
Humanities and Social Sciences > Society > Population and Demography > Mortality and Longevity
Risk Factors
Life Sciences > Health Sciences > Public Health > Health Promotion and Disease Prevention > Risk Factors
  • BMC Nephrology BMC Nephrology

    This is an open access journal publishing original peer-reviewed research articles in all aspects of the prevention, diagnosis and management of kidney and associated disorders, as well as related molecular genetics, pathophysiology, and epidemiology.

Your space to connect: The Cancer in understudied populations Hub

A new Communities’ space to connect, collaborate, and explore research on Cancers, Race and Ethnicity Studies and Mortality and Longevity!

Continue reading announcement

Related Collections

With Collections, you can get published faster and increase your visibility.

Biomarkers in kidney disease diagnosis

BMC Nephrology is calling for submissions to our Collection on Biomarkers in kidney disease diagnosis.

Kidney disease remains a pressing global health issue, affecting millions and often leading to significant morbidity and mortality. The identification of reliable biomarkers has emerged as a promising avenue for enhancing the diagnosis and management of kidney diseases. Biomarkers can provide critical insights into the pathophysiology of renal conditions, facilitate early detection, and help tailor treatment strategies to individual patients. With the advent of advanced technologies in molecular biology and genomics, there is a growing interest in understanding how specific biomarkers can improve clinical outcomes in kidney disease.

The significance of advancing biomarker research in kidney disease diagnosis is underscored by recent breakthroughs in the identification of novel biomarkers that improve accuracy and timeliness in detection. These advancements are crucial for the early intervention and management of chronic kidney disease (CKD) and acute kidney injury (AKI). As research continues to evolve, integrating biomarkers into clinical practice can revolutionize the way kidney diseases are diagnosed, monitored, and treated. Furthermore, innovative biomarker applications may allow for better stratification of risk in populations at high risk for kidney disease, paving the way for proactive health management strategies.

Topics of interest for this Collection include, but are not limited to:

Novel biomarkers for kidney disease diagnosis

Early detection methods in kidney pathology

Clinical applications of renal biomarkers

Biomarkers and chronic kidney disease management

This Collection supports and amplifies research related to SDG 3 (Good Health and Well-being) and SDG 9 (Industry, Innovation, and Infrastructure).

All manuscripts submitted to this journal, including those submitted to collections and special issues, are assessed in line with our editorial policies and the journal’s peer review process. Reviewers and editors are required to declare competing interests and can be excluded from the peer review process if a competing interest exists.

Publishing Model: Open Access

Deadline: Jan 30, 2026

Images in nephrology

BMC Nephrology is calling for submissions to our Collection on Images in nephrology.

This will be a unique collection where all submissions to the collection that meet consideration criteria will be included in an image competition. The Guest Editors for this collection will be the referees and will judge each image based on pre-defined criteria. We welcome submissions in the form of case reports, commentary articles and literature reviews to present their image. All images relating to the vast field of nephrology will be considered for publication and participation in the competition. The winner will receive a full APC waiver for their submission and for one future publication in BMC Nephrology. The second and third place winners will receive a full APC waiver for their submission to the collection. 1st and 2nd place winners will be invited to contribute to the BMC Nephrology blog. All winners will also be eligible for an invitation to BMC Editors Day – to visit a Springer Nature location and meet editorial staff.

Inspired by the multidisciplinary nature of our field, we want to welcome submissions that highlight the beauty of day-to-day nephrology. Intraoperative images, laboratory photographs, microscopy findings, anatomical models, hand-drawn art, radiology images and more will be considered. The image should be accompanied by a case report, commentary or review, describing the findings and importance of the image, the case or story behind it. Novelty will not be a criteria for consideration. Patient images are required to have appropriate patient consent for publication. Images accompanied by commentary and submitted as commentary articles will be considered on a case-by-case basis. Literature reviews will be considered pending editorial approval. In order to be published and considered in the competition, the articles must abide by scholarly publishing standards and journal guidelines.

The judges will evaluate the images based on, but not limited to, the following:

Image uniqueness

Adherence to BMC Nephrology scope

Quality and content of the image

Educational and public interest

Case and story behind the image

Submissions will be assessed for adherence to journal guidelines and publishing standards. Manuscripts that are rejected will be withdrawn from the competition automatically. If a manuscript is accepted, it will participate in the final evaluation by judges. All accepted manuscripts will be embargoed until the judging is completed. We will aim to carry out final judging quickly, as to not delay the publication of submitted works. The final day to submit a manuscript for consideration in the image contest will be November 1st, 2025. Final results will be tallied by November 30th, 2025 and the winners will be announced shortly after. The winners will be provided with an APC waiver immediately. All submitted manuscripts will undergo standard peer review and editorial evaluation as necessary.

All manuscripts submitted to this journal, including those submitted to collections and special issues, are assessed in line with our editorial policies and the journal’s peer review process. Reviewers and editors are required to declare competing interests and can be excluded from the peer review process if a competing interest exists.

Publishing Model: Open Access

Deadline: Dec 31, 2025