Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs. A prospective multicenter observational study.

Abstract

Background High blood pressure is a prevalent condition in patients with chronic kidney disease on hemodialysis. Adequate control of high blood pressure is essential to reduce deaths in this group of patients. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point of care dry weight (POCW) technique. Methods The present observational, prospective study was carried out at the Pafram Hemodiafiltration Unit in Morona Santiago, Ecuador, and the Hemodialysis Unit of the Fundación Renal del Ecuador in Guayaquil, Ecuador, from August 2019 to December 2023. Patients who were receiving hemodiafiltration were included. Weight was optimized with POCW. Group 1 included patients whose antihypertensive agents were not required to control blood pressure with a value less than 150/85 mmHg predialysis at eight weeks of POCW. In group 2, the patients required antihypertensive therapy. Clinical data, demographic data, mortality data, treatment descriptions, and routine laboratory test results during dialysis were included. The sample was nonprobabilistic. Survival analysis was carried out for the study groups. The log-rank test (Mantel-Cox) was used for survival comparisons. Results The study included 106 patients. Optimal blood pressure control without antihypertensive treatment was achieved in 52 patients (49.1%) (Group 1). In 54 patients (50.9%), antihypertensive agents were required (Group 2). There was more significant mortality in the group that received antihypertensives: 11 patients in group 1 (21.2%) versus 25 patients in group 2 (46.3%) (P = 0.005). Survival was more significant in group 1, with an HR of 2.2163 (1.125–4.158) (P = 0.0243). Conclusion Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs.