[Prognostic significance of controlled and uncontrolled arterial hypertension in patients with terminal kidney failure on chronic hemodialysis]

Abstract

Aim: To assess prognostic implications of controlled and uncontrolled arterial hypertension (AH) in patients with terminal renal failure (TRF) on chronic hemodialysis (CHD).

Material and methods: 90 patients on CHD treated from 1981 to 2001 participated in the trial. All of them were examined morphologically (biopsy of the kidney or autopsy). According to the trend of arterial pressure during CHD treatment they were divided into 3 groups. 72 patients of group 1 had sodium-dependent AH. 8 patients of group 2 had uncontrollable AH (rise of arterial pressure during hemodialysis in spite of controlled iltrafiltration). Group 3 consisted of control patients.

Results: It was found that any hypertension in CHD patients is prognostically unfavourable. Controllable AH occurred in 91.1%, uncontrollable--in 8.9% of examinees. Chronic renal failure in 20% of group 1 patients was associated with rapidly progressive nephritis, in 15%--with systemic vasculitides. In group 2, 38% patients had systemic vasculitis, 50%--rapidly progressive nephritis. The activity of the underlying disease in hemodialysis was registered in 75 and 30% patients of group 2 and 1, respectively. Incomplete dialysis syndrome (IDS) was diagnosed in 69.6% group 1 and 40.0% group 2 patients.

Conclusion: Sodium dependent arterial hypertension was most frequent. It is attributed to IDS. AH uncontrolled by hemodialysis develops, as a rule, in patients with systemic vasculitis or active primary nephritis. Uncontrollable AH is characterized by elevated plasm renin. Lack of control over arterial pressure in hemodialysis is essential for long-term survival of the patients. The shortest survival was observed in patients with renin-dependent AH. Factors provoking AH and deteriorating the prognosis are the following: hypervolemia in IDS, hyperactivity of plasm renin, exacerbation of basic disease in hemodialysis, protein energy deficiency syndrome, lack of residual renal function.