Nephrology Dialysis Transplantation, Vol 12, Issue 3 485-491, Copyright © 1997 by Oxford University Press
JE Ventura and M Sposito
BACKGROUND: The influence of interdialysis (ID) volume expansion on the
blood pressure (BP) change and on the BP level at the end of the ID time
period was studied in 167 chronic haemodialysis patients. Our analysis
focused on 120 patients not receiving antihypertensive drugs (untreated
group). The remaining 47 patients were receiving antihypertensive
medication (treated group). METHODS: The ID weight gain was considered
equivalent to the volume gain. In each patient the mean ID BP change (as
percent change of initial BP) and the mean ID volume expansion related to
the lean body mass (ml.kg-1) were determined from 25 consecutive ID time
periods. The individual volume sensitivity of BP was expressed as the BP
change divided by the volume expansion. Basal overhydration was estimated
as mean ID initial weight minus dry weight. RESULTS: All patients gained
volume during ID time periods and the BP was increased in 91%. The change
of mean BP (MBP) was directly correlated with volume expansion (r = 0.45, P
< 0.00001) only in the untreated group. These patients showed a volume
sensitivity unrelated with age, serum urea and calcium concentrations and
haematocrit. Sensitivity of diastolic BP (DBP), an indicator of the
capacity to respond to volume expansion by vasoconstriction (autoregulatory
process), exhibited a negative correlation with the initial DBP level (r =
-0.36, P < 0.0001) and with the serum potassium (in women, r = -0.35, p
< 0.02). These factors appeared to counteract the volume-induced DBP
response. The MBP levels at the end of ID time periods were independent of
volume expansion and basal overhydration. Hypertensive patients showed a
higher sensitivity than normotensive patients (0.35 +/- 0.2 versus 0.20 +/-
0.19% per ml.kg-1, P < 0.005). Final MBP showed a positive correlation
with initial MBP and, to a smaller extent, with serum urea concentration.
CONCLUSIONS: In our study the ID change of BP is partially dependent on
volume gain. Volume sensitivity is a measure of the BP responsiveness and
is higher in hypertensive patients. Final BP depends on the height of
initial BP and other factors accounting for volume sensitivity, whose
precise nature remain to be clarified.
ORIGINAL ARTICLES
Volume sensitivity of blood pressure in end-stage renal disease
Centro de Nefrologia de la Universidad de la Republica, Montevideo, Uruguay.
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