Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP)
Top Cited Papers
- 1 March 2009
- journal article
- research article
- Published by Wolters Kluwer Health in Hypertension
- Vol. 53 (3) , 500-507
- https://doi.org/10.1161/hypertensionaha.108.125674
Abstract
Volume excess is thought to be important in the pathogenesis of hypertension among hemodialysis patients. To determine whether additional volume reduction will result in improvement in blood pressure (BP) among hypertensive patients on hemodialysis and to evaluate the time course of this response, we randomly assigned long-term hypertensive hemodialysis patients to ultrafiltration or control groups. The additional ultrafiltration group (n=100) had the dry weight probed without increasing time or duration of dialysis, whereas the control group (n=50) only had physician visits. The primary outcome was change in systolic interdialytic ambulatory BP. Postdialysis weight was reduced by 0.9 kg at 4 weeks and resulted in −6.9 mm Hg (95% CI: −12.4 to −1.3 mm Hg; P=0.016) change in systolic BP and −3.1 mm Hg (95% CI: −6.2 to −0.02 mm Hg; P=0.048) change in diastolic BP. At 8 weeks, dry weight was reduced 1 kg, systolic BP changed −6.6 mm Hg (95% CI: −12.2 to −1.0 mm Hg; P=0.021), and diastolic BP changed −3.3 mm Hg (95% CI: −6.4 to −0.2 mm Hg; P=0.037) from baseline. The Mantel-Hanzel combined odds ratio for systolic BP reduction of ≥10 mm Hg was 2.24 (95% CI: 1.32 to 3.81; P=0.003). There was no deterioration seen in any domain of the kidney disease quality of life health survey despite an increase in intradialytic signs and symptoms of hypotension. The reduction of dry weight is a simple, efficacious, and well-tolerated maneuver to improve BP control in hypertensive hemodialysis patients. Long-term control of BP will depend on continued assessment and maintenance of dry weight.Keywords
This publication has 36 references indexed in Scilit:
- On the Importance of Pedal Edema in Hemodialysis PatientsClinical Journal of the American Society of Nephrology, 2008
- Statistics in Medicine — Reporting of Subgroup Analyses in Clinical TrialsNew England Journal of Medicine, 2007
- Effect of Frequent Nocturnal Hemodialysis vs Conventional Hemodialysis on Left Ventricular Mass and Quality of LifeJAMA, 2007
- Improvement in “uremic” cardiomyopathy by persistent ultrafiltrationHemodialysis International, 2007
- Pre- and Postdialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood PressureClinical Journal of the American Society of Nephrology, 2006
- Improvement in Blood Pressure With Inhibition of the Epithelial Sodium Channel in Blacks With HypertensionHypertension, 2005
- Chronic Kidney Disease and the Risks of Death, Cardiovascular Events, and HospitalizationNew England Journal of Medicine, 2004
- Clinical assessment of dry weightNephrology Dialysis Transplantation, 1996
- Development of the Kidney Disease Quality of Life (KDQOLTM) InstrumentQuality of Life Research, 1994
- Survival as an index of adequacy of dialysisKidney International, 1992