Abstract
Overhydration is reported to be the main cause of hypertension (HTN) as well as to have no association with HTN in hemodialysis (HD) population. This is the first report of the relationship between interdialytic weight gain (IDWG) and pre-HD blood pressure (BP) in pediatric patients in relation to residual urine output (RUO). We studied 170 HD sessions and interdialytic periods performed during a 12-week period in 5 patients [age 4–17 years, weight 20.8–66 kg, 3 anuric (102 HD sessions), and 2 nonanuric (68 HD sessions)]. BP is presented as systolic BP index (SBPI) and diastolic BP index (DBPI), calculated as systolic or diastolic BP/95th percentile for age, height, and gender. IDWG did not differ (P > 0.05) between anuric and nonanuric pts. There was a positive but not significant correlation between IDWG and both pre-HD SBPI (r = 0.833, P = 0.080) and pre-HD DBPI (r = 0.841, P = 0.074). Pre-HD SBPI (1.01 ± 0.12 versus 1.13 ± 0.18) and DBPI (0.92 ± 0.16 versus 1.01 ± 0.24) were higher in nonanuric patents (P < 0.001 and P < 0.01, resp.). Pre-HD HTN may not be solely related to IDWG and therapies beyond fluid removal may be needed. Individualized approach to HTN management is necessary in pediatric dialysis population.
Highlights
Role of interdialytic weight gain (IDWG) in hypertension (HTN) is poorly defined
Several studies investigated how IDWG relates to blood pressure (BP) in dialyzed children, the effect of residual urine output (RUO) on IDWG and pre-HD BP in this population has not been studied [1,2,3, 6]
We found significantly higher pre-HD systolic BP index (SBPI) and diastolic BP index (DBPI) in nonanuric pts in comparison to anuric pts
Summary
Role of interdialytic weight gain (IDWG) in hypertension (HTN) is poorly defined. While some report overhydration as the main cause of HTN, others find that it is frequently not associated with HTN, in both adults and children [1,2,3,4]. Relationship between IDWG and blood pressure (BP) may vary between children of different age and size and may be affected by growth and associated variations in total body water, dry weight (DW), and necessary fluid intake to meet nutritional needs, as well as nonadherence to medications and fluid restriction. Several studies investigated how IDWG relates to BP in dialyzed children, the effect of residual urine output (RUO) on IDWG and pre-HD BP in this population has not been studied [1,2,3, 6] This is the first report of different relationships between IDWG and pre-HD BP in relation to RUO in pediatric patients (pts) on chronic HD
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