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Effects of frequent hemodialysis on blood pressure: Results from the randomized frequent hemodialysis network trials
Author(s) -
Kotanko Peter,
Garg Amit X.,
Depner Tom,
Pierratos Andreas,
Chan Christopher T.,
Levin Nathan W.,
Greene Tom,
Larive Brett,
Beck Gerald J.,
Gassman Jennifer,
Kliger Alan S.,
Stokes John B.
Publication year - 2015
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1111/hdi.12255
Subject(s) - medicine , hemodialysis , blood pressure , randomized controlled trial , dialysis , kidney disease , relative risk , confidence interval , surgery , cardiology
Hypertension is a common complication of chronic kidney disease and persists among most patients with end‐stage renal disease despite the provision of conventional thrice weekly hemodialysis ( HD ). We analyzed the effects of frequent HD on blood pressure in the randomized controlled F requent H emodialysis N etwork trials. The daily trial randomized 245 patients to 12 months of 6× (“frequent”) vs. 3× (“conventional”) weekly in‐center hemodialysis; the nocturnal trial randomized 87 patients to 12 months of 6× weekly nocturnal HD vs. 3× weekly predominantly home‐based hemodialysis. In the daily trial, compared with 3× weekly HD , 2 months of frequent HD lowered predialysis systolic blood pressure by −7.7 mmHg [95% confidence interval ( CI ): −11.9 to −3.5] and diastolic blood pressure by −3.9 mmHg [95% CI : −6.5 to −1.3]. In the nocturnal trial, compared with 3× weekly HD , 2 months of frequent HD lowered systolic blood pressure by −7.3 mmHg [95% CI : −14.2 to −0.3] and diastolic blood pressure by −4.2 mmHg [95% CI : −8.3 to −0.1]. In both trials, blood pressure treatment effects were sustained until month 12. Frequent HD resulted in significantly fewer antihypertensive medications (daily: −0.36 medications [95% CI : −0.65 to −0.08]; nocturnal: −0.44 mediations [95% CI : −0.89 to −0.03]). In the daily trial, the relative risk per dialysis session for intradialytic hypotension was lower with 6×/week HD but given the higher number of sessions per week, there was a higher relative risk for intradialytic hypotensive requiring saline administration. In summary, frequent HD reduces blood pressure and the number of prescribed antihypertensive medications.