Interdialytic weight gain and 48-h blood pressure in haemodialysis patients.

and is the main cause of mortality in haemodialysis Background. Hypertension, which is often associated patients [2]. Furthermore, this trend has not changed with hypervolaemia, is common in haemodialysis over the past 15 years [1 ]. Risk factors for patients and is a known determinant of target organ cardiovascular disease in the general population damage. Interdialytic weight gain due to volume over- include hypertension, left ventricular hypertrophy, lipid load has also been associated with mortality in haemo- abnormalities, and glucose intolerance [3 ], and all of dialysis patients. these factors are more frequently observed in the Methods. We therefore studied 27 chronic haemodia- ESRD population [4 ]. lysis patients who underwent 48-h ambulatory blood Hypertension may be present in up to 80% of pressure monitoring between two midweek dialysis patients reaching end-stage renal disease [5 ], sometimes sessions, and 2D and M-mode echocardiography for as a primary cause of renal failure but more usually determination of left ventricular mass index. as a secondary complication. In dialysis patients the Results. Left ventricular hypertrophy ( left ventricular latter is commonly attributed to increased circulating mass index in men>131 g/m2, women>100 g/m2) was intravascular volume, so-called volume-dependent present in 70% ( 19/27) patients despite a mean 48-h hypertension, which is partially assessed by the interblood pressure of 132±19/81±15 mmHg. Mean inter- dialytic weight gain and controlled by fluid removal dialytic weight gain was 1.6±0.8 kg and was not during dialysis to the appropriate dry weight. This related to left ventricular mass index. Two patterns of practice assumes a direct relationship between weight interdialytic blood pressure change were apparent: in gain and increased blood pressure (BP), and indeed group 1 ( 16 patients) 48-h blood pressure increased interdialytic weight gain has been directly related to (+19±12/13±9 mmHg), whereas in group 2 (11 cardiovascular mortality in haemodialysis patients [6 ]. patients) blood pressure fell (’10±13/’8±10 mmHg However recently it has been suggested that this relaP<0.0001). In both groups the number of hypertensive tionship may not be so clear cut in either normotensive patients (group 1, 10/16; group 2, 6/11), the 48-h blood or hypertensive haemodialysis patients [7]. pressure (132±20/80±15 vs 132±18/82±15 mmHg) Several studies have shown left ventricular hyperand interdialytic weight gain (+1.9±0.7 vs trophy ( LVH ) to be a major independent predictor of +1.3±0.7 kg) were similar. There was also no corremortality both in the general population [8] and in lation between interdialytic blood pressure change and patients with ESRD, in whom LVH is a common weight gain in either group. finding. Conclusions. We conclude that interdialytic blood pressure changes cannot be directly related to interdialytic Therefore in the present study we aimed to examine fluid gain, even in apparent volume-dependent hyper- interdialytic weight gain in relation to 48-h blood tension, emphasizing the importance of additional fac- pressure (BP) profiles and the incidence of LVH in tors in the control of blood pressure in end-stage our haemodialysis ( HD) population. renal disease.