Long-slow home hemodialysis produced superior blood pressure control compared to short in-center hemodialysis, with lower pre- and postdialysis systolic and ambulatory blood pressures.
RCT (n=9)
Crossover
Does long-slow home hemodialysis improve blood pressure control compared to standard in-center hemodialysis in home hemodialysis patients?
Long-slow home hemodialysis provides superior blood pressure control compared to standard in-center hemodialysis, independent of extracellular fluid volume changes.
We conducted a randomized crossover trial to establish, within patients, whether long-slow hemodialysis (HD) was associated with better blood pressure (BP) control than standard HD. Nine home HD patients, not on antihypertensive drugs, were dialyzed to the same eKt/Vurea 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, bioimpedance, neurohormones and autonomic function were measured in each phase. Pre- and postdialysis systolic, ambulatory systolic and diastolic BP were all higher with SD than with LD and intradialysis hypotension was more common. Weight, ECF volume and neurohormones did not differ between treatments. Muscle sympathetic activity was increased in both phases and cardiac sympathetic activity tended higher during SD. These findings suggest that additional factors to ECF volume may contribute to the superior BP control produced by long-slow HD.
McGregor et al. (Mon,) conducted a rct in End-stage renal disease requiring hemodialysis (n=9). Long-slow home hemodialysis vs. Short in-center hemodialysis (3.5-4.5 hours, 3 times weekly) was evaluated on Blood pressure control. Long-slow home hemodialysis produced superior blood pressure control compared to short in-center hemodialysis, with lower pre- and postdialysis systolic and ambulatory blood pressures.