Key result
Frequent and prolonged hemodialysis permits better control of hypertension and improves cardiac geometry in end-stage renal disease patients compared to conventional hemodialysis.
Why the study?
Does frequent and prolonged daily hemodialysis improve hypertension control in patients with end-stage renal disease compared to conventional hemodialysis?
Does frequent and prolonged daily hemodialysis improve hypertension control in patients with end-stage renal disease compared to conventional hemodialysis?
Frequent and prolonged daily hemodialysis offers a physiological advantage over conventional hemodialysis in managing hypertension and reducing left ventricular hypertrophy in ESRD patients.
Answers are grounded in this paper and cite their sources.
May support intensified hemodialysis for ESRD hypertension; leaves open confirmation of cardiac benefits in randomized trials.
Hypertension is present in 60-90% of patients on maintenance hemodialysis (HD) and it is an important cause of cardiovascular (CV) mortality and morbidity. Frequent and prolonged HD has been uniformly shown to control hypertension in end-stage renal disease (ESRD) patients more effectively than conventional HD. The etiology of hypertension is predominantly volume dependent, but in a subset of patients increased renin, sympathetic overactivity, and endothelial dysfunction may play a role. Intradialytic hypotension precludes attainment of dry weight and hence optimal control of hypertension in conventional HD is challenging. Frequent and prolonged dialysis with gentle and persistent ultrafiltration allows time for refilling of the intravascular compartment and permits normalization of extracellular volume. It is also possible that intensive dialysis enables removal of pressor molecules and improves endothelial function. Improved blood pressure control translates into regression of left ventricular hypertrophy in patients on daily HD. Thus prolonged and frequent dialysis permits better control of hypertension via volume and volume-independent mechanisms and also improves cardiac geometry.
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Saad et al. (2004) conducted a review in Hypertension in end-stage renal disease patients on maintenance hemodialysis. Frequent and prolonged hemodialysis vs. Conventional hemodialysis was evaluated. Frequent and prolonged hemodialysis permits better control of hypertension and improves cardiac geometry in end-stage renal disease patients compared to conventional hemodialysis.
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