Mustafa Altay, Murat Duranay, Nurçin Tekeli, Serdar Güler, Zafer Aydın Ecemiş, Fatma Aybala Altay

THE RELATION BETWEEN VOLUME LOAD AND BLOOD PRESSURE IN HEMODIALYSIS PATIENTS

Anahtar Kelimeler:

-

THE RELATION BETWEEN VOLUME LOAD AND BLOOD PRESSURE IN HEMODIALYSIS PATIENTS

Aim: To investigate the effect of hemodialysis on blood pressure by monitoring ambulatory blood pressure during the interdialysis period and to evaluate the relationship between hypertension and the percentage of total body water calculated via bioelectrical impedance analysis. Methods: Twenty five patients with end stage renal disease who were in the hemodialysis program were included in the study. But only fifteen patients had been able to stay in the required criteria till the end. Pre- and post-dialysis blood pressures of the patients were measured manually and ambulatory blood pressure measurements were obtained during the interdialysis period. Measurements of total body water were performed with bioelectrical impedance method following the hemodialysis procedure. The patients were evaluated for daily course of blood pressure, use of anti-hypertensive medications, incidence of the falling rate of blood pressure at night, amount of total body water and interdialysis weight gain. Results: Manual pre- and post-dialysis measurements and mean values of 44 hours’ ambulatory blood pressure monitoring were found to be similar. Blood pressures were found to be significantly low until the 24th hour and they were increased at the 2nd day, then returned to initial levels at the 44th hour. There was uncontrolled hypertension in 7 of the 11 hypertensive patients (63.6 %). Mean percentage of total body water was higher in patients with hypertension (61.1 ±9.8 vs. 57.9±7.0, p>0.05). Conclusion: In our study, the reducing effect of hemodialysis on blood pressure was observed and this effect has continued nearly 24 hours after the dialysis. The fact that total body water is more in hypertensive patients supports the idea that volume excess is an important factor responsible from hypertension

Keywords:

bioelectrical impedance, hemodialysis blood pressure,

PDF

___

Salem MM. Hypertension in the dialysis population: No easy answers. Int J Artif Organs 1996;19:693-4
Raine A, Margreiter R, Brunner F. Report on management of renal failure in Europe, XXII, 1991. Nephrol Dial Transplant 1992;2:7-35
US Renal Data System. USRDS 1997 Annual Data Report: The National Institutes of Health, National Institutes of Diabetes and Digestive and Kidney Disease, Bethesda, MD, 1997. Causes of death. Am J Kidney Dis 1997 (suppl 1) 30:S107-S117
Scribner BH. Reducing mortality in dialysis patients: Why does hypertension continue to be overlooked? Seminars in Dialysis 1997;10:250
United States Renal Data System 1998 Annual Data Report. Medication use among dialysis patients. Am J Kidney Dis 1998;32 (suplement 1);S60-68
Staessen JA, Beilin L, Parati G, Waeber B, White W. Task force IV: Clinical use of ambulatory blood pressure monitoring. Participants of the 1999 Consensus conference on Ambulatory Blood Pressure Monitoring. Blood Press Monit 1999;4:319-31
The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. the JNC 7 report. JAMA 2003; 289: 2560-74
De Lorenzo A, Deurenberg P, Sasso G, Palestini M, Docimo R. Multifrequency impedance in the assessment of body water losses during dialysis. Renal Physiol Biochem 1994;17:326-32
Fisch B, Spiegel D. Assessment of excess fluid distribution in chronic hemodialysis patients using bioimpedance spectroscopy. Kidney Int 1996;49:1105-9
Lopot F, Nejedly B, Novotna H, Mackova M, Sulkova S.Age-related extracellular to total body water volume ratio (Ecv/TBW)--can it be used for “dry weight” determination in dialysis patients? Application of multifrequency bioimpedance measurement. Int J Artif Organs 2002;25:762-9
Dumler F.Best method for estimating urea volume of distribution: comparison of single pool variable volume kinetic modeling measurements with bioimpedance and anthropometric methods. ASAIO J 2004;50: 237-41
Luik AJ, Charra B, Katzarski K, et al. Blood pressure control and hemodynamic changes in patients on long time dialysis treatment. Blood Purif 1998;16:197-209
Elisaf M, Pappas H, Kalaitzidis R, et al. Ambulatory blood pressure monitoring in hemodialysis patients. J Human Hypertens 1996; 10 (Suppl 3): S43-S47
Agarwal R. Role of Home Blood Pressure Monitoring in Hemodialysis Patients. Am J Kidney Dis 1999;33:682-7
Batlle DC, von Riotte A, Lang G: Delayed hypotensive response to dialysis in hypertensive patients with end-stage renal disease. Am J Nephrol 1986;6:14-20
Kaplan NM (ed). Clinical Hypertension, Williams and Wilkins, 7 th edition, Baltimore, 1998;P:323-44
Gavros H. How does salt raise blood pressure? An hypothesis, Hypertension 1986;8:83-8 ,
Schwartz AB, Mintz GS, Kim GE, et al. Recombinant human erythropoietin increases MAP, TPRI and systolic and diastolic dysfunction with increased impedance to LV ejection due to increased HCT and rbc mass in patients with CRF. Kidney Int 1989;35: 334
Katzarski K, Charra B, Laurent G, et al. Multifrequency bioimpedance in assessment of dry weight in haemodialysis. Nephrol Dial Transplant 1996;11:20-3
Alvarez-Lara MA, Martin-Malo A, Espinosa M,Rodriguez-Benot A, Aljama P. Blood pressure and body water distribution in chronic renal failure patients. Nephrol Dial Transplant 2001;16:94-7