Nephrology Dialysis Transplantation, Vol 14, Issue 2 369-375, Copyright © 1999 by Oxford University Press
K Katzarski, B Charra, A Luik, J Nisell, J Filho, J Leypoldt, K Leunissen, G Laurent and J Bergstrom
Background: Patients treated at the haemodialysis (HD)
centre in Tassin, France have been reported to have superior survival and
blood pressure (BP) control. This control has been ascribed to maintenance
of an adequate fluid state, antihypertensive drugs being required in
<5% of the patients, although it could not be excluded that a high
dose of HD regarding removal of uraemic toxins might also have been of
value. Methods: The aim of the study was to assess the
fluid state and BP in normotensive patients on long HD (8h) in Tassin
(group TN) using bioimpedance to measure extracellular volume (ECV),
ultrasound for determining the inferior vena cava diameter (IVCD), and
'on-line' monitoring of the change in blood volume (BV), and to compare
them with normotensive (group SN) and hypertensive (group SH) patients on
short HD (3-5 h) at centres in Sweden. ECV was normalized (ECVn) by
arbitrarily setting the median ECV (in % of body weight) in SN patients at
100% for each gender, recalculating the individual values and combining the
results for male and female patients in each group.
Results: The dose of HD (Kt/V urea) was higher for TN
patients than for Swedish patients who had similar Kt/V, whether
hypertensive or not. SH patients had significantly higher ECVn and IVCD
than TN and SN patients. TN and SN patients did not differ significantly
regarding ECVn and IVCD before and after HD. However, in a subgroup of
eight TN patients, ECVn was below the range of that in SH and SN patients,
due to obesity with a high body mass index. Another subgroup of 15 TN
patients had a higher ECVn than most of the SN patients and also higher
than the median ECVn in the SH group, without any difference in body mass
index, but they were nevertheless normotensive. The fall in BV was greater
in SN than in TN patients, presumably due to a higher ultrafiltration rate
in SN patients. However, SH patients had a smaller change in BV than SN
patients, presumably because their state of overhydration facilitated
refilling of BV from the interstitial fluid.
Conclusions: Normotension can be achieved
independently of the duration and dose (Kt/V urea) of HD, if the control of
post-dialysis ECV is adequate. However, this is more difficult to achieve
with short than with more prolonged HD during which the ultrafiltration
rate is lower, BV changes are smaller and intradialysis symptoms less
frequent. The results in the subgroup of patients with high ECVn at Tassin
suggest that normotension may also be achieved in patients with fluid
overload provided that the dialysis time is long enough to ensure more
efficient removal of one or more vasoactive factors that cause or
contribute to hypertension. Key words: blood volume;
chronic renal failure; extracellular volume, fluid state; haemodialysis;
hypertension
ORIGINAL ARTICLES
Fluid state and blood pressure control in patients treated with long and short haemodialysis
Divisions of Renal Medicine and Baxter Novum, Department of Clinical Science, Karolinska Institute, Huddinge University Hospital, K56, 141 86 Huddinge, Sweden; Centre de Rein Artificiel de Tassin, Tassin, France; Department of Internal Medicine, St Maartens Gasthuis, Venlo, The Netherlands; Department of Nephrology, University Hospital, Maastricht, The Netherlands; Dialysis Unit, Regional Hospital, Mora, Sweden; Dialysis Unit, Sophialhemmet Hospital, Stockholm, Sweden; Research Service, Veteran Affairs Medical Center, and the Departments of Medicine and Bioengineering, University of Utah, Salt Lake City, UT, USA; Corresponding author
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