Short daily hemodialysis: Blood pressure control and left ventricular massreduction in hypertensive hemodialysis patients

Several retrospective and uncontrolled prospective studies reported blood p ressure (BP) normalization and left ventricular mass (LVM) reduction during daily hemodialysis (DHD). Conversely, the burden of these major independen t risk factors is only marginally reduced by the initiation of standard thr ice-weekly dialysis (SHD), and cardiovascular events still represent the mo st common cause of death in hemodialysis patients. Therefore, we performed a randomized two-period crossover study to compare the effect of short DHD versus SHD on BP and LVM in hypertensive patients with end-stage renal dise ase. We studied 12 hypertensive patients who had been stable on SHD treatme nt for more than 6 months. At the end of 6 months of SHD and 6 months of DH D in a sequence of randomly assigned 24-hour ambulatory BP monitoring, echo cardiography and bioimpedance were performed. Throughout the study, patient s maintained the same Kt/V. A significant reduction in 24-hour BP during DH D was reported (systolic BP [SBP]: DHD, 128 +/- 11.6 mm Hg; SHD, 148 +/- 19 .2 mm Hg; P < 0.01; diastolic BP: DHD, 67 +/- 8.3 mm Hg; SHD, 73 +/- 5.4 mm Hg; P = 0.01). The decrease in BP was accompanied by the withdrawal of ant ihypertensive therapy in 7 of 8 patients during DHD (P < 0.01). LVM index ( LVMI) decreased significantly during DHD (DHD, 120.1 +/- 60.4 g/m(2); SHD, 148.7 +/- 59.7 g/m(2); p = 0.01). Extracellular water (ECW) content decreas ed from 52.7% +/- 11.4% to 47.6% +/- 7.5% (P = 0.02) and correlated with 24 -hour SBP (r = 0.63; P < 0.01) and LVMI (r = 0.66; P < 0.01). In conclusion , this prospective crossover study confirms that DHD allows optimal control of BID, reduction in LVMI, and withdrawal of antihypertensive treatment. T hese effects seem to be related to reduction in ECW content. (C) 2001 by th e National Kidney Foundation, Inc.