Research Article of Global Journal of Urology and Nephrology
Ultrafiltration (UF) Effectiveness on intradialytic hypertension (IDH) in chronic hemodialysed patients in a nephrology unit in Dakar: UF-IDH clinical trial
Ba Bacary 1, Faye Moustapha 1, Keita Niakhaleen 1, Lemrabott Ahmed Tall 1, Seck Sidy Mohamed 2, Faye Maria 1, Mbengue Mansour 1, Diagne Seynabou 1, Ba Mamadou Aw 1, Dieng Ahmed 1, Kane yaya 3, Diouf Boucar 1, Niang Abdou 1, Ka Elhadji Fary 1
1Department of Nephrology, Dialysis and Renal Transplantation of Aristide Le Dantec University Hospital, Cheikh Anta Diop University, Dakar, Senegal. 2Department of nephrology and dialysis of the Military Hospital of Ouakam, Gaston Berger University of Saint Louis, Senegal. 3Departement of nephrology and dialysis of the regional hospital of Ziguichor, Assane Seck university of Ziguinchor, Senegal.
Progressive ultrafiltration (UF) could improve IDH. The aim of this work was to evaluate the effectiveness of progressive UF in the management of IDH.
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.
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%).
Progressive UF was associated with a significant reduction in the prevalence of IDH in our patients at week 4.
Keywords: intradialytic hypertension – ultrafiltration – hemodialysis – Dakar.
How to cite this article:
Ba Bacary, Faye Moustapha, Keita Niakhaleen, Lemrabott Ahmed Tall, Seck Sidy Mohamed, Faye Maria, Mbengue Mansour, Diagne Seynabou, Ba Mamadou Aw, Dieng Ahmed, Kane yaya, Diouf Boucar, Niang Abdou, Ka Elhadji Fary. Ultrafiltration (UF) Effectiveness on intradialytic hypertension (IDH) in chronic hemodialysed patients in a nephrology unit in Dakar: UF-IDH clinical trial. Global Journal of Urology and Nephrology, 2021, 4:25. DOI: 10.28933/gjun-2020-05-1405
1. Cirit M, Akcicek F, Terzioglu E, et al. ‘Paradoxi-cal’ rise in blood pressure during ultrafiltration in dialysis patients. Nephrol Dial Transplant. 1995;10(8):1417–20.
2. National Kidney Foundation. K/DOQI: Clinical practice guidelines on hypertension and antihy-pertensive agents in chronic kidney disease. Am J Kidney Dis. 2004;43(5 Suppl 1):S1- 290.
3. Inrig Jk. Intradialytic hypertension. A less-recognized cardiovascular complication of he-modialysis. Am J Kidney Dis. 2010;55(3):580-9.
4. Sinomono DTE, Dami F, Ndiaye A et al. Hyper-tension intradialytique : incidence et facteurs de risques. Néph & Thér. 2015;11:287–337.
5. Sebastian S, Filmater C, Harvey Jet al. Intradi-alytic hypertension during chronic hemodialysis and subclinical fluid overload assessed by bi-oimpedance spectroscopy. Clin Kidney J. 2016;9(4):636–43.
6. FAYE Mo. Hypertension intradialytique : préva-lence et facteurs de risques associés chez les hémodialysés chronique au Sénégal. Mémoire de médecine. Dakar: UCAD; 2017, N° 227.
7. Losito A, Vecchio LD, Rosso GD et al. Postdial-ysis Hypertension : Associated Factors, Patient Profiles, and Cardiovascular Mortality. Am J Hy-pert. 2016;29(6):684-89
8. Inrig JK, Oddone EZ, Hasselblad V et al. Asso-ciation of intradialytic blood pressure changes with hospitalization and mortality rates in preva-lent ESRD patients. Kidney Int. 2007;71:454–461.
9. Agarwal R, Light RP. Intradialytic hypertension is a marker of volume access. Nephrol Dial Trans-plant. 2010;25(10):3355-61.
10. Nongnuch A, Campbell N, Stern E, et al. In-creased postdialysis systolic blood pressure is associated with extracellular overhydration in hemodialysis outpatients. Kidney Int. 2015;87(2):452–7.
11. Davenport A. Intradialytic complications during hemodialysis. Hemodial Int. 2006;
12. Fellner SK. Intradialytic hypertension II. Semin Dial. 1993;6:371-373
13. Mackanga JR, Oliveira G, F. Ehoumba et al. Var-iation paradoxale de la pression artérielle sys-tolique en fin de dialyse : prévalence et facteurs associés. Néph & Thér. 2016;12:294.
14. Reddan DN, Szczech LA, Hasselblad V et al. In-tradialytic blood volume monitoring in ambulato-ry hemodialysis patients: a randomized trial. J Am Soc Nephrol. 2005;16:2162-2169.
15. Inrig JK, Patel UD, Toto RD et al. Association of blood pressure increases during hemodialysis with 2-year mortality in incident hemodialysis pa-tients : a secondary analysis of the Dialysis Morbidity and Mortality Wave 2 Study. Am J Kidney Dis. 2009;54:881-890.
16. Agarwal R, Alborzi P, Satyan S, Light RP. Dry-weight reduction in hypertensive hemodialysis patients (DRIP): a randomized, controlled Trial. Hypertension. 2009;53(3):500–7.
17. Loutradis C, Pantelis A, Ekart SR et al. The ef-fect of dry-weight reduction guided by lung ul-trasound on ambulatory blood pressure in he-modialysis patients: a randomized controlled trial. kid int. 2019;95(6): 1505–13.
18. Charra B, Chazot C. Analyse critique des méthodes de mesures du volume extra-cellulaire en dialyse. Nephrol & Ther. 2007;3(Suppl 2):S112-120
19. Agarwal R , Weir MR. Dry-Weight: A Concept Revisited in an Effort to Avoid Medication- Di-rected Approaches for Blood Pressure Control in Hemodialysis Patients. Clin J Am Soc Nephrol. 2010;5 (7):1255-1260;
20. Ren H, Gong D, He X, et al. Evaluation of Intra-dialytic Hypertension Using Bioelectrical Imped-ance Combined With Echocardiography in Maintenance Hemodialysis Patients. Ther Apher Dial. 2018;22(1):22-30.
21. Ozkahya M, Ok E, Toz H, et al. Long-term sur-vival rates in haemodialysis patients treated with strict volume control. Nephrol Dial Transplant. 2006;21:3506–13.
CC BY 4.0
This work and its PDF file(s) are licensed under a Creative Commons Attribution 4.0 International License.