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Randomized Controlled Trial
. 2021 Jul 1;39(7):1444-1452.
doi: 10.1097/HJH.0000000000002818.

Ambulatory blood pressure changes with lung ultrasound-guided dry-weight reduction in hypertensive hemodialysis patients: 12-month results of a randomized controlled trial

Charalampos Loutradis  1 , Pantelis A Sarafidis  1 , Robert Ekart  2 , Ioannis Tsouchnikas  1 , Christodoulos Papadopoulos  3 , Vasileios Kamperidis  4 , Maria Eleni Alexandrou  5 , Charles J Ferro  6 , Aikaterini Papagianni  1 , Gerard London  7 , Francesca Mallamaci  8 , Carmine Zoccali  8
Affiliations
Randomized Controlled Trial

Ambulatory blood pressure changes with lung ultrasound-guided dry-weight reduction in hypertensive hemodialysis patients: 12-month results of a randomized controlled trial

Charalampos Loutradis et al. J Hypertens. .

Abstract

Objectives: Hypertension is highly prevalent and independently associated with adverse outcomes in patients undergoing hemodialysis. Volume overload is the main mechanism of increased blood pressure (BP) in these individuals. This study examines the long-term effects of dry-weight reduction with a standardized lung-ultrasound (US)-guided strategy on ambulatory BP in hypertensive hemodialysis patients.

Methods: This is the report of the 12-month follow-up of a randomized controlled trial in 71 clinically euvolemic, hemodialysis patients with hypertension. Patients were randomized to dry-weight reduction guided by prehemodialysis lung ultrasound and to standard care. A 48-h ambulatory BP monitoring (ABPM) was performed in all study participants at baseline and after 12 months.

Results: During follow-up, a greater proportion of patients in the active group underwent dry-weight reduction compared with the control group (71.4% vs. 22.2%; P < 0.001). The number of lung US-B lines (a metric of lung water) reduced in the active (-4.83 ± 13.73) and increased in the control arm (+5.53 ± 16.01; P = 0.005) paralleling dry-weight changes (-1.68 ± 2.38 vs. 0.54 ± 2.32 kg; P < 0.001). At 12 months, 48-h systolic BP (136.19 ± 14.78 vs. 130.31 ± 13.57 mmHg; P = 0.034) and diastolic BP (80.72 ± 9.83 vs. 76.82 ± 8.97 mmHg; P = 0.008) were lower compared to baseline in the active but similar in the control group. Changes in 48-h systolic BP (-7.78 ± 13.29 vs. -0.10 ± 14.75 mmHg; P = 0.021) were significantly greater in the active compared to the control group. The proportion of patients experiencing ≥1 episode of intradialytic hypotension was nominally lower in the active group (71.4% vs. 88.9%, P = 0.065).

Conclusions: Lung-US-guided dry-weight reduction can effectively and safely decrease ambulatory BP levels in the long-term.

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References

    1. Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG. Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Am J Med 2003; 115:291–297.
    1. Sarafidis PA, Mallamaci F, Loutradis C, Ekart R, Torino C, Karpetas A, et al. Prevalence and control of hypertension by 48-h ambulatory blood pressure monitoring in haemodialysis patients: a study by the European Cardiovascular and Renal Medicine (EURECA-m) working group of the ERA-EDTA. Nephrol Dial Transplant 2018; 33:1872doi:10.1093/ndt/gfy263. - DOI
    1. Saran R, Robinson B, Abbott KC, Bragg-Gresham J, Chen X, Gipson D, et al. US renal data system 2019 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis 2020; 75:A6–A7.
    1. Loutradis CN, Tsioufis C, Sarafidis PA. The clinical problems of hypertension treatment in hemodialysis patients. Curr Vasc Pharmacol 2017; 16:54–60.
    1. Sarafidis PA, Persu A, Agarwal R, Burnier M, de Leeuw P, Ferro CJ, et al. Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney Working Group of the European Society of Hypertension (ESH). Nephrol Dial Transplant 2017; 32:620–640.

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