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.
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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.

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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
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