CKD Is Associated With Difficult-to-Control Blood Pressure

Blood pressure (BP) is difficult to control among patients with chronic kidney disease on hemodialysis or peritoneal dialysis, regardless of the number of hypotensive drugs used, according to a recent study. Mean BP was not related to hydration status among this patient population.

Findings were presented on August 28, 2017, by Dr Rodrigo de Oliveira Pierami at the 2nd Annual Kidney Congress in Philadelphia, Pennsylvania.
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To explore the relationship between BP and hydration status among this patient population, the researchers assessed 89 patients with chronic kidney disease receiving hemodialysis (n = 69) or peritoneal dialysis (n = 20) at a dialysis center in Brazil. The majority of participants were men and Caucasian, and mean patient age was 57.6 years.

Data on patient BP, demographics, and number of antihypertensive drugs were recorded. Hydration status was collected via bioimpendance examinations.

At baseline, 27.5% of patients had a systolic BP of less than 140 mmHg, 81.2% of patients had a diastolic BP of less than 90 mmHg, and 43.8% had a mean BP of more than 100 mmHg with an overall hydration level of 0.5 liters.

After hemodialysis, 40.6% of patients had a systolic BP within the normal range, and 79.7% had a diastolic BP within the normal range. After peritoneal dialysis, 55% had a normal systolic BP, and 85% had a normal diastolic BP. In addition, 56.2% of patients had a mean BP of more than 100 mmHg after treatment with an overall hydration level of 1.5 liters.

Patients were stratified into 4 groups after the researchers combined pre-dialysis systolic BP and hydration status. About 40% of patients with high BP and hyperhydration were categorized in group 1; 25% who had high BP independent of hyperhydration were categorized in group 2; 19%  were categorized in group 3, with 9% being hypohydrated and having low BP; and 16% with high BP were categorized in group 4, with 12% having normal BP and hydration levels and 4% deemed hyperhydrated and having either normal BP or arterial hypotension.

“In this research, there was noted the difficulty of controlling BP in these patients despite the use of expressive [numbers of antihypertensive drugs] and no relation between [hydration status] and [mean BP],” the researchers concluded.

—Christina Vogt

Reference:

de Oliveira Pierami R. Evaluation of arterial hypertension in chronic kidney patients on hemodialysis and peritoneal dialysis. Paper presented at: 2nd Annual Kidney Congress; August 28-30, 2017. Philadelphia, PA. http://kidney.conferenceseries.com/abstract/2017/evaluation-of-arterial-hypertension-in-chronic-kidney-patients-on-hemodialysis-and-peritoneal-dialysis.