Diet and dialysis to control hypertension in patients on dialysis

Introduction: Uncontrolled hypertension in hemodialysis (HD) patients is related to a variety of causes, of which dietary salt intake plays a major role. Excessive interdialytic weight gain (IDWG) with accompanying hypertension can lead to increase cardiovascular morbidity and mortality. Materials and Methods: We conducted a cross-sectional observational study to assess the prevalence of hypertension among patients on maintenance HD (MHD) and its relationship with daily sodium intake. We included participants who were getting MHD at out tertiary care center and in whom a digital brachial blood pressure (BP) was measured. Results: Of the 118 patients studied, 73 (61.9%) were male. AVF was the access for HD in 88 (74.6%) patients, 22 (18.6%) patients were getting HD through a permcath, and the rest through a temporary central venous HD catheter. HD was being done once a week for 3 (2.5%) patients, 80 (67.8%) patients were getting HD twice a week, and the others thrice a week. The mean pre-HD BP was 151.7/80 ± 22.55/12.8 mmHg, and the mean post-HD BP was 168/90.9 ± 23.7/11.3 mmHg. An IDWG of <2 kg was seen in 32 (32.2%) patients; the remaining patients had an IDWG of >2 kg. The mean IDWG was 2.41 kg. Seventeen (14.4%) patients were not on any antihypertensive medications, 48 (40.7%) patients were taking 1–2 antihypertensive drugs, and the rest were on >3 antihypertensive drugs. A urine output of <100 ml/day was present in 45 (38.1%) patients; the rest had a daily urine output of over 100 ml up to 1000–1200 ml. Nutritional assessment by a trained dietician showed that sodium intake ranged from 1700 mg to 2200 mg/day. Conclusion: Dietary sodium intake was controlled in our HD patients with the intake of 1700–2200 mg per day. The weight gain was excessive in 67.8% of our patients, Patients were ingesting 1–5 antihypertensive drugs of different classes and 14.4% were not on any antihypertensive drugs. Dialysis was being done twice a week for 67.8% of our patients and thrice a week for 29.7% of patients. We found hypertension in 85.6% of our cohort.