Nephrology, Dialysis and Renal Transplantation Unit and CNR-IBIM Clinical epidemiology and Pathophysiology of Renal Diseases and Hypertension, United Hospitals, Reggio Calabria, Italy.
J Nephrol. 2011 Jul-Aug;24(4):465-73. doi: 10.5301/JN.2011.7735.
Hypertension remains a major problem in hemodialysis (HD) patients.
We performed a pragmatic trial (Pragmatic Clinical Intervention on Blood Pressure Driven by Audit [CLINIDEA]) testing the effectiveness and safety of a 6-month multimodal intervention in hypertensive HD patients regarding the application of higher ultrafiltration (UF) rates or longer or more frequent dialyses in UF-intolerant patients, and an educational intervention to encourage patients to lower their salt and fluid intake.
Blood pressure (BP) in hypertensive patients (n=32) fell from 156.8 ± 13.3 / 81.1 ± 8.9 mm Hg to 147.9 ± 18.8 / 77.5 ± 11.1 mm Hg. UF intensification was well tolerated, and the BP goal was achieved without resorting to longer or more frequent dialyses. BP changes were paralleled by a consistent (p<0.01) fall in dry body weight. The trial largely failed at increasing compliance with salt prescription (salt intake: baseline: 156.9 ± 64 mEq/day, 6-month: 150.7 ± 60.3 mEq/day). During the 12 months preceding the trial, the hospitalization rates for arteriovenous (AV) fistula complications and cardiovascular (CV) events were identical in hypertensive and in normotensive patients. However, these complications selectively increased (AV complications: relative risk [RR] = 7.6; CV complication: RR=8.4) in hypertensive patients coinciding with UF intensification during the trial. Increasing the UF rate is an effective BP-lowering intervention in HD patients. However, this intervention is associated with a higher risk for AV complications and CV events.
Longer and/or more frequent dialyses and better efforts to increase compliance to low salt diets than those put in place in this study are needed to reduce the high prevalence of hypertension in the HD population.
高血压仍然是血液透析（HD）患者的主要问题。
我们进行了一项实用临床试验（由审计驱动的血压干预的实用临床干预[CLINIDEA]），测试了在超滤不耐受患者中应用更高超滤率或更长或更频繁透析以及教育干预以鼓励患者减少盐和液体摄入的 6 个月多模式干预在高血压 HD 患者中的有效性和安全性。
高血压患者（n=32）的血压从 156.8±13.3/81.1±8.9mmHg 降至 147.9±18.8/77.5±11.1mmHg。超滤强化治疗耐受性良好，在不延长或增加透析频率的情况下达到血压目标。血压变化与干体重持续下降（p<0.01）相一致。该试验在增加盐处方的依从性方面基本失败（盐摄入量：基线：156.9±64mEq/天，6 个月：150.7±60.3mEq/天）。在试验前的 12 个月中，动静脉（AV）瘘并发症和心血管（CV）事件的住院率在高血压患者和正常血压患者中相同。然而，这些并发症在试验期间随着超滤强化治疗而选择性增加（AV 并发症：相对风险[RR]=7.6；CV 并发症：RR=8.4）。增加超滤率是降低 HD 患者血压的有效干预措施。然而，这种干预与 AV 并发症和 CV 事件的风险增加相关。
需要比本研究中实施的更长和/或更频繁的透析以及更好地努力增加对低盐饮食的依从性，以降低 HD 人群中高血压的高患病率。
