Arterial hypertension and hemodialysis multi-centric study

Abstract

The prevalence of hypertension (HT) is important in hemodialysis patients, HT partially explains the high frequency of cardiovascular morbidity and mortality in these patients. Epidemiological studies have shown that the prevalence of HT in hemodialysis varies from 50 to 80% depending on age and the causal pathology of chronic kidney disease. The goal of this work was to measure the blood pressure in chronic hemodialysis patients in order to determine the prevalence of HT and to describe the predictive factors of HT and to establish a strategy for individual management of HT in our dialysis patients. Multicenter cross-sectional study conducted in five hemodialysis centers. 510 patients undergoing hemodialysis for over six months were included, their mean age was 56 ± 15 years-old with a male predominance: sex/ratio 1.40. Regular monitoring of blood pressure was performed before dialysis, during and at the end of the session, with adjustment based on the factors affecting blood pressure measured by laboratory tests (calcium and phosphor levels, PTH, hemoglobin level and ionogram) for six weeks. An echocardiography was performed for patients with uncontrolled HT despite pharmacological treatment and hygienic-dietary measures. Initial nephropathy was of vascular origin in 25% of patients; 30% had diabetic origin and 10% resulted from glomerular nephropathies. Fifty-five % of patients were hypertensive; HT was more prevalent in men with diabetes; the patients had echocardiographic abnormalities. While HT in patients treated with erythropoietin was 30%, 41% of the hypertensives had a hydro-sodic retention and 90% of the anuric patients were hypertensive. The HT was predominantly systolic in 70% of hypertensive patients. The blood pressure increased linearly with respect to the duration of the hemodialysis period. Hypertension is common in chronic hemodialysis patients. The expansion of extracellular volume likely plays a major role in HT; underlining the need to fix dry weight for each patient and the individualisation of dialysis characteristics. Cardiac repercussions are frequent in hemodialysis patients, hence the interest of echocardiographic examination, which must be systematic and periodic for each patient undergoing extra-renal purification.