Key result
Taking more than two antihypertensive medications did not significantly alter the 30-day readmission rate for CHF or fluid overload compared to two or fewer medications (18% vs 16%; p=0.663).
Why the study?
Does the quantity of antihypertensive medications alter the 30-day readmission rate for CHF, fluid overload, or pulmonary edema in chronic hemodialysis patients?
Observational (n=85)
No
Does the quantity of antihypertensive medications alter the 30-day readmission rate for CHF, fluid overload, or pulmonary edema in chronic hemodialysis patients?
The quantity and class of antihypertensive medications do not significantly alter the 30-day readmission rate for fluid overload or CHF in chronic hemodialysis patients.
Does not support changing antihypertensive regimens to reduce readmissions in hemodialysis; leaves open prospective trials on medication burden.
BACKGROUND: In hemodialysis, hypertension is treated by removing excess fluid and antihypertensive therapy. Commonly, the antihypertensives used to treat hypertension in earlier stages of kidney disease are continued as the patient progresses into end-stage renal disease and begins dialysis, without much evidence for benefit. METHODS: This study is a single center, retrospective chart review that included hemodialysis patients admitted for congestive heart failure (CHF), fluid overload, or pulmonary edema as determined by ICD-9 code (428.x, 276.6, 518.4, 506.1). The primary objective was to determine if the number or class of antihypertensives used in the chronic hemodialysis population increased the number of readmissions related to CHF, fluid overload, or pulmonary edema. Patients were separated into two groups based on total number of antihypertensive medications, less than or equal to 2 medications for group 1 and greater than two medications for group 2. The primary endpoint was 30-day readmission for CHF, fluid overload, or pulmonary edema. RESULTS: For the study period, 85 individual patient charts met inclusion criteria. Group 1 (n = 44) experienced seven readmissions (16%) and group 2 (n = 41) experienced eight readmissions (18%) (p = 0.663). The most common antihypertensives at discharge were ACE inhibitors for group 1 (45%) and dihydropyridine calcium channel blockers for group 2 (66%). No difference in systolic blood pressures before, during and after hemodialysis was found between groups. CONCLUSIONS: Antihypertensive medications continue to play an important role in the hemodialysis population. This study suggests that drug class and quantity of antihypertensives do not alter readmission rate in the setting of fluid overload.
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Honkonen et al. (2015) conducted an observational in Hemodialysis patients admitted for congestive heart failure, fluid overload, or pulmonary edema (n=85). >2 antihypertensive medications vs. ≤2 antihypertensive medications was evaluated on 30-day readmission for CHF, fluid overload, or pulmonary edema (p=0.663). Taking more than two antihypertensive medications did not significantly alter the 30-day readmission rate for CHF or fluid overload compared to two or fewer medications (18% vs 16%; p=0.663).
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