Blood pressure control in dialysis patients

Background Chronic kidney disease is associated with 18-fold increased cardiovascular risk. I Iypcrtcnsion (HTN) is an ubiquitous finding in dialysis patients and the blood pressure (BP) control is often very poor in this group. The etiology of HTN in end-stage renal disease is multifactorial thus BP control requires multidirectional, frequently aggressive, treatment and is one of the major challenge of nephrologists and hypertensiologists. The aim of the study was to assess blood pressure control in treated with haemodialysis (HD group) and peritoneal dialysis (PD group) patients. Material and methods The retrospective analysis of 168 (mean age 62y) patients: 104 haemodialysis and 64 peritoneal dialysis patients was made based on the medical documentation. The medical history, BP measurements-before and after three HD sessions in HD group and twice a visit during three visits in PD group, body mass, residual diuresis, laboratory tests, the presence of peripheral edema and the echocardiography were taken. The kind of using hypotensive drugs and the connection between the number of them, the presence of volume overload, the presence of residual diuresis and BP control was analyzed. Results I ID patients were significantly older than PD group (Me = 64 v. Me = 57.5y, p < 0.05) and were treated with dialysis longer (Me = 33.6 v. Me = 27.5 mths, p < 0.05). There were no significant differences in the frequency of BP rates above > 140/90 mm Hg. Diastolic BP was significantly lower in HD group (74.49 +/- 12.57 v. 83.78 +/- 12.15 mm Hg, p < 0.05). The residual diuresis was less present in HD group (44% v. 62%, p < 0.05). The median 24-hour urine collection value was 50 ml in HD group and 350 ml in PD group, p < 0.05. The peripheral edema was observed significantly more often in PD group with uncontrolled BP (above 140/90 mm Hg) (72.2% v. 35.7%, p < 0.05). The mean body mass gain between the HD sessions in HD group was 2 +/- 2.1 kg. The average amount of hypotensive drugs was 2 in HD and 3 in PD patients. The most used hypotensive drug was betablocker. PD patients were treated with ACE-I and ARB significantly wider (p < 0.05). There were no differences in Echo parameters. Conclusions There were a better BP and volume control in HD group. We affirmed the connection between BP control, volume status and the duration of dialysis, especially in PD patients. There should be the more aggressive salt dietary restriction and the better volume control in our PD patients and also ACE-I should be used more widely, particularly in patients with the high risk of cardiovascular disease.