Real world treatment of hypertension on hemodialyses-data from large Polish database

The prevalence of hypertension among patients with end stage kidney disease (ESKD) undergoing hemodialysis (HD) ranges from 72-88% depending on applied diagnostic criteria and chosen method of blood pressure measurement. Despite the guidelines recommending the widespread use of renin angiotensin system blockers (RASB) in patients with kidney disease, their utilization in patients on HD may be suboptimal, especially in patients with preserved diuresis. This hesitance often steams from concern is often due to fear of a decrease in eGFR and a subsequent decrease in diuresis. The aim of this study was to compare clinical characteristics, blood pressure, safety, and hemodialysis adequacy indices in hypertensive HD patients on multiple antihypertensive drug regimens, including diuretic treated with RASB (RASB group) or without RASB (no-RASB) with preserved residual diuresis. We sought to examine the real life use of RASB in hemodialysis patients in relation to their clinical characteristics, blood pressure, safety, and hemodialysis adequacy. From a database of 5879 patients receiving hemodialysis (mean age 65.2±14.2 yrs., 60% of males) of the largest provider of HD in the country, we selected the subgroup treated with at least three antihypertensive medications including diuretics. We compared patients treated with RASB to counterparts without RASB (no-RASB). RASB group has similar age and gender proportions as well as BMI and bioimpedance,compared to counterparts. However, dry body mass was significantly lower in the RASB group (78.1±18.3 kg vs. 80.0±18.2 kg, p