Kayikcioglu Meral, Tumuklu Murat, Ozkahya Mehmet, Ozdogan Oner, Asci Gulay, Duman Soner, Toz Huseyin, Can Levent H, Basci Ali, Ok Ercan
Department of Cardiology, Ege University School of Medicine, Izmir.
Nephrol Dial Transplant. 2009 Mar;24(3):956-62. doi: 10.1093/ndt/gfn599. Epub 2008 Nov 11.
Most haemodialysis (HD) centres use anti-hypertensive drugs for the management of hypertension, whereas some centres apply dietary salt restriction strategy. In this retrospective cross-sectional study, we assessed the effectiveness and cardiac consequences of these two strategies.
We enrolled all patients from two dialysis centres, who had been on a standard HD programme at the same centre for at least 1 year. All patients underwent echocardiographic evaluation. Clinical data were obtained from patients' charts. Centre A (n = 190) practiced 'salt restriction' strategy and Centre B (n = 204) practiced anti-hypertensive-based strategy. Salt restriction was defined as managing high blood pressure (BP) via lowering dry weight by strict salt restriction and insistent ultrafiltration without using anti-hypertensive drugs.
There was no difference regarding age, gender, diabetes, history of cardiovascular disease and efficiency of dialysis between centres. Antihypertensive drugs were used in 7% of the patients in Centre A and 42% in Centre B (P < 0.01); interdialytic weight gain was significantly lower in Centre A (2.29 +/- 0.83 kgversus 3.31 +/- 1.12 kg, P < 0.001). Mean systolic and diastolic blood pressures were similar in the two centres. However, Centre A had lower left ventricular (LV) mass (indexed for height(2.7): 59 +/- 16 versus 74 +/- 27 g/m(2.7), P < 0.0001). The frequency of LV hypertrophy was lower in Centre A (74% versus 88%, P < 0.001). Diastolic and systolic functions were better preserved in Centre A. Intradialytic hypotension (hypotensive episodes/100 patient sessions) was more frequent in Centre B (11 versus 27, P <0.01).
This cross-sectional study suggests that salt restriction and reduced prescription of antihypertensive drugs may limit LV hypertrophy, better preserve LV functions and reduce intradialytic hypotension in HD patients.
大多数血液透析（HD）中心使用抗高血压药物来管理高血压，而一些中心采用饮食限盐策略。在这项回顾性横断面研究中，我们评估了这两种策略的有效性及对心脏的影响。
我们纳入了来自两个透析中心的所有患者，这些患者在同一中心接受标准HD治疗至少1年。所有患者均接受了超声心动图评估。临床数据从患者病历中获取。中心A（n = 190）采用“限盐”策略，中心B（n = 204）采用基于抗高血压药物的策略。限盐定义为通过严格限盐和坚持超滤降低干体重来控制高血压（BP），而不使用抗高血压药物。
两个中心在年龄、性别、糖尿病、心血管疾病史和透析效率方面无差异。中心A中7%的患者使用抗高血压药物，中心B中这一比例为42%（P < 0.01）；中心A的透析间期体重增加显著更低（2.29±0.83 kg对3.31±1.12 kg，P < 0.001）。两个中心的平均收缩压和舒张压相似。然而，中心A的左心室（LV）质量更低（根据身高指数化：59±16对74±27 g/m(2.7)，P < 0.0001）。中心A左心室肥厚的发生率更低（74%对88%，P < 0.001）。中心A的舒张和收缩功能保存更好。中心B的透析中低血压（低血压发作次数/100患者治疗次数）更频繁（11对27，P <0.01）。
这项横断面研究表明，限盐和减少抗高血压药物处方可能会限制HD患者的左心室肥厚，更好地保存左心室功能，并减少透析中低血压。
