A comparative study of blood pressure control with short in-center versus long home hemodialysis

We conducted a randomized crossover trial to establish, within patients, wh ether long-slow hemodialysis (HD) was associated with better blood pressure (BP) control than standard HD. Nine home HD patients, not on antihypertens ive drugs, were dialyzed to the same eKt/V-urea and target weights for 6-8 h (LD) at home and for 3.5-4.5 h (SD) in the dialysis center 3 times weekly in randomized sequence, with each phase lasting 8 weeks. Ambulatory BP, bi oimpedance, neurohormones and autonomic function were measured in each phas e. Pre- and postdialysis systolic, ambulatory systolic and diastolic BP wer e all higher with SD than with LD and intradialysis hypotension was more co mmon. Weight, ECF volume and neurohormones did not differ between treatment s. Muscle sympathetic activity was increased in both phases and cardiac sym pathetic activity tended higher during SD. These findings suggest that addi tional factors to ECF volume may contribute to the superior BP control prod uced by long-slow HD. Copyright (C) 2001 S. Karger AG, Basel.