Honkonen Marcella N, McNeill Patrick, Jasensky Alex, Erstad Brian L
a College of Pharmacy, University of Arizona , Tucson , AZ , USA .
b Banner University Medical Center , Tucson , AZ , USA .
Ren Fail. 2016;38(1):40-5. doi: 10.3109/0886022X.2015.1103655. Epub 2015 Oct 29.
In hemodialysis, hypertension is treated by removing excess fluid and antihypertensive therapy. Commonly, the antihypertensives used to treat hypertension in earlier stages of kidney disease are continued as the patient progresses into end-stage renal disease and begins dialysis, without much evidence for benefit.
This study is a single center, retrospective chart review that included hemodialysis patients admitted for congestive heart failure (CHF), fluid overload, or pulmonary edema as determined by ICD-9 code (428.x, 276.6, 518.4, 506.1). The primary objective was to determine if the number or class of antihypertensives used in the chronic hemodialysis population increased the number of readmissions related to CHF, fluid overload, or pulmonary edema. Patients were separated into two groups based on total number of antihypertensive medications, less than or equal to 2 medications for group 1 and greater than two medications for group 2. The primary endpoint was 30-day readmission for CHF, fluid overload, or pulmonary edema.
For the study period, 85 individual patient charts met inclusion criteria. Group 1 (n = 44) experienced seven readmissions (16%) and group 2 (n = 41) experienced eight readmissions (18%) (p = 0.663). The most common antihypertensives at discharge were ACE inhibitors for group 1 (45%) and dihydropyridine calcium channel blockers for group 2 (66%). No difference in systolic blood pressures before, during and after hemodialysis was found between groups.
Antihypertensive medications continue to play an important role in the hemodialysis population. This study suggests that drug class and quantity of antihypertensives do not alter readmission rate in the setting of fluid overload.
在血液透析中，高血压通过清除过多液体和抗高血压治疗来处理。通常，在肾病早期用于治疗高血压的抗高血压药物会在患者进展到终末期肾病并开始透析时继续使用，但获益证据并不充分。
本研究是一项单中心回顾性病历审查，纳入了因充血性心力衰竭（CHF）、液体过载或肺水肿入院的血液透析患者，通过国际疾病分类第九版编码（428.x、276.6、518.4、506.1）确定。主要目的是确定慢性血液透析人群中使用的抗高血压药物的数量或类别是否会增加与CHF、液体过载或肺水肿相关的再入院次数。患者根据抗高血压药物的总数分为两组，第1组使用的药物少于或等于2种，第2组使用的药物多于2种。主要终点是因CHF、液体过载或肺水肿导致的30天再入院。
在研究期间，85份个体患者病历符合纳入标准。第1组（n = 44）有7例再入院（16%），第2组（n = 41）有8例再入院（18%）（p = 0.663）。出院时最常用的抗高血压药物，第1组是血管紧张素转换酶抑制剂（45%），第2组是二氢吡啶类钙通道阻滞剂（66%）。两组在血液透析前、透析期间和透析后的收缩压没有差异。
抗高血压药物在血液透析人群中继续发挥重要作用。本研究表明，在液体过载的情况下，抗高血压药物的类别和数量不会改变再入院率。
