Nephrol Dial Transplant (2003) 18: 2332-2338
© 2003 European Renal Association-European Dialysis and Transplant Association
Original Article
Association between extracellular water, left ventricular mass and hypertension in haemodialysis patients
1Department of Nephrology-Dialysis and 2Department of Cardiology, Silvestrini Hospital, Perugia, Italy
Correspondence and offprint requests to: Riccardo Maria Fagugli, MD, S. C. Nefrologia e Dialisi, Ospedale Silvestrini, Azienda Ospedaliera di Perugia, S. Andrea delle Fratte, 06100 Perugia, Italy. Email: rmfag{at}tin.it
Background. Hypertension and left ventricular hypertrophy (LVH) are present in the majority of patients undergoing haemodialysis (HD). These two pathologies persist after dialysis onset, and pharmacological therapy is often required for adequate control of blood pressure (BP). Although fluid overload is a determinant of hypertension, clinical assessment of this parameter remains difficult and unsatisfactory. Bioimpedance analysis (BIA) spectroscopy and the relative determination of extracellular water (ECW%) may provide a simple and inexpensive tool for investigating fluid overload. We studied 110 patients on thrice-weekly HD to determine whether ECW body content correlates with hypertension and LVH in this patient population.
Methods. Hypertension was determined according to the WHO criteria (office BP 
140/90 and/or the use of antihypertensive therapy). Twenty-four hour BP monitoring and echocardiography were performed on midweek inter-HD days. Blood chemistries, dialysis dose (spKt/V) and bioimpedance were analysed on midweek HD days.
Results. Hypertension was present in 74.5% of patients. There were no differences for age, spKt/V, haemoglobin, serum creatinine and residual renal function between normotensive and hypertensive patients. Twenty-four hour systolic BP (SBP), 24 h diastolic BP and 24 h pulse pressure were higher in hypertensive patients, in spite of antihypertensive therapy. LVH was present in 61.8% of patients. BIA revealed that ECW% was increased in LVH+ patients (LVH+ = 47.5 ± 7.9%, LVH– = 42.4 ± 6.2%, P = 0.01) and in hypertensive patients compared with normotensives (46.5 ± 7.7% vs 43 ± 7.2%, P = 0.02). Dry body weights and inter-HD body weight increases did not differ between hypertensive and normotensive patients nor between patients with or without LVH. ECW was correlated with SBP (r = 0.35, P < 0.01) and with left ventricular mass index (LVMig/sqm) (r = 0.49, P < 0.001). A stepwise multiple linear regression model revealed that LVMig/sqm was significantly correlated with ECW%, SBP and male gender (r = 0.65, P < 0.001).
Conclusions. LVH and hypertension are present in a majority of HD patients and they are closely correlated with one another. We found associations between fluid load, measured by BIA and expressed as ECW, and BP and LVM.
Keywords: extracellular water; haemodialysis; hypertension; left ventricular hypertrophy
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