Key result
Progressive ultrafiltration significantly increased the disappearance of intradialytic hypertension at 4 weeks compared to control (83.3% vs 41.7%, HR 0.29).
Why the study?
Progressive ultrafiltration could improve intradialytic hypertension, but its effectiveness in managing the condition needed evaluation.
Does progressive ultrafiltration improve intradialytic hypertension in chronic hemodialysis patients?
RCT (n=24)
Open-label
1:1
No
Does progressive ultrafiltration improve intradialytic hypertension in chronic hemodialysis patients?
Hazard Ratio: 0.29 (95% CI 0.14–0.59)
Absolute Event Rate: 83.3% vs 41.7%
p-value: p=0.035
Progressive ultrafiltration significantly reduces the prevalence of intradialytic hypertension at 4 weeks, though it is associated with increased side effects requiring treatment discontinuation in over a third of patients.
Progressive UF may reduce IDH in hemodialysis; supports larger RCTs to confirm benefit before practice change.
Introduction Progressive ultrafiltration (UF) could improve IDH. The aim of this work was to evaluate the effectiveness of progressive UF in the management of IDH. Methods This randomized clinical trial in two groups: interventional group A (UF, n = 12) and control group B (n = 12), was conducted in chronic hemodialysis patients with IDH. A first phase of cross-sectional collection of BP before and after dialysis, during 2 weeks, made it possible to obtain this cohort of 24 patients. A progressive decrease in basal weight of 0.25 kg per session as a function of hemodynamic tolerance was achieved in group A. The primary endpoint, the proportion of patients with disappearance of IDH, was assessed at baseline end of the 4th and 8th week. Results At the 4th week, the IDH disappeared in 83.3% and 41.7% of the patients of the group A and B respectively with a hazard ratio (HR) at 0.29; IC 95 = [0.14-0.59]; p = 0.035. At the 8th week, the IDH was missing in 72.7% and 66.7% of the patients of the group A and B respectively with a HR at 0.76; IC 95 = [0.58-1.00]; p = 0.75. In addition, the decrease in basal weight was associated with the occurrence of side effects (p = 0.0001) with a HR of 5 [1.45-7.27]. UF discontinuation was required in 4 patients in group A (36.4%). Conclusion Progressive UF was associated with a significant reduction in the prevalence of IDH in our patients at week 4.
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A 2021 study conducted an RCT in Intradialytic hypertension (n=24). Progressive ultrafiltration vs. Control was evaluated on Proportion of patients with disappearance of intradialytic hypertension at week 4 (HR 0.29, 95% CI 0.14-0.59, p=0.035). Progressive ultrafiltration significantly increased the disappearance of intradialytic hypertension at 4 weeks compared to control (83.3% vs 41.7%, HR 0.29).
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