P-163: Intense ultrafiltration for normalization of blood pressure during hospitalization in patients with dialysis refractory hypertension

The prevalence of uncontrolled hypertension [HTN] among chronic hemodialysis [HD] patients is high and ranges from 59 to 80%.Blood pressure [BP] control is volume- dependent in most HD patients but in a subset of patients with dialysis refractory hypertension [DRH], BP remains high post HD. Inadequate ultrafiltration [UF], poor medication compliance, elevated renin, endothelin, and asymmetrical dimethylarginine [ADMA] levels may be contributary to DRH. The effect of hospitalization with intensive UF on BP control remains subjective.We retrospectively reviewed our records and identified 41 patients with DRH who have been hospitalized over the last 4 years [1999–2003].The effect of hospitalization and intensive UF on BP control is reported. All patients are African Americans with a mean ( ± SD) age of 55 ±11 yr.,63% female [26 of 41] who were hospitalized for volume overload with and without hyperkalemia.All were subjected to daily HD for 2–3 days with intensive UF.The mean pre-hospitalization systolic and diastolic BP's were 203 ± 24 mmHg and 110 ± 13 mmHg respectively, while the mean out patient interdialytic weight gain [IDWG] was 5 ± 2 kg (range 2–9 kg). At hospital discharge, the mean weight loss was 8 ± 2 kg (range 2–12 kg).There was a 40% reduction of the mean arterial pressure [MAP] from the pre-hospitalization levels ( mean difference 58 mmHg, p < 0.0001) and 29% reduction in number of BP medications (4 ±1 vs 3 ±1, p < 0.0001 ). Regression analysis showed a significant association between dialysis clinic MAP and other factors : IDWG ( R = 0.5, p = 0.002); coccaine usage ( R = 0.3, p = 0.005); smoking ( R = 0.23, p = 0.02) and alcohol abuse ( R = 0.34, p = 0.003). The normalized BP was only sustained for a brief duration and quickly rose to near pre-hospitalization levels.The MAP at one month post-hospitalization was significantly higher than the level at hospital discharge ( 122 ± 12 mmHg vs 83 ± 7 mmHg, p = 0.001), but still less than the pre-hospitalization levels ( mean difference 19 mmHg, p = 0.001). Dialysis refractory hypertension appears to be an out patient phenomenon which can be induced by a combination of both modifiable and non-modifiable factors. However, it can be mitigated by life style modification, optimization of BP medications with attention to compliance and adequate UF. Am J Hypertens (2004) 17, 93A–93A; doi: 10.1016/j.amjhyper.2004.03.238