Dry-weight reduction improves intradialytic hypertension only in patients with high predialytic blood pressure.

Abstract

The aim of this study was to investigate whether additional volume reduction by ultrafiltration can improve blood pressure in patients with intradialytic hypertension (IDH) defined as at least 10 mmHg systolic blood pressure (SBP) rise during hemodialysis. This prospective, open-label, single-center study included 11 IDH patients with normal predialytic blood pressure (BP) (group A), 11 IDH patients with high predialytic BP (group B), and 18 patients without IDH as control. Serum angiotensin-II, aldosterone (ALD), angiotensin-converting enzyme, endothelin-1, nitric oxide, and asymmetric dimethylarginine were measured before and after the treatments. Basic angiotensin-converting enzyme, ALD, endothelin-1, and asymmetric dimethylarginine serum levels were significantly increased in group B compared with control (P < 0.05). On comparing the results from the first and 13th dialysis sessions in group A, the dry weight was reduced by - 0.15 ± 0.16 kg after 12 sessions and the predialytic SBP increased by 3.18 ± 6.25 mmHg before and by 7.37 ± 14.90 mmHg at 4 h during the 13th session. In group B, the dry weight was reduced by 0.67 ± 0.53 kg (P = 0.006 vs. group A) at the 13th session and they had - 12.09 ± 16.20 mmHg less SBP before (P = 0.009 vs. group A) and - 11.82 ± 14.66 mmHg at 4 h of the 13th session. The decrease in dry weight was associated with significantly higher decreases in angiotensin-II and ALD serum levels in group B compared with group A. Reducing fluid overload in IDH patients with high predialytic BP can effectively improve their BP, but had no effect on BP in normal predialytic BP IDH cases.