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Relationship between Interdialytic Weight Gain and Blood Pressure in Pediatric Patients on Chronic Hemodialysis

Olivera Marsenic1, Michael Anderson2, Kevin G Couloures3

  • 1Pediatric Nephrology, Yale University, New Haven, CT, USA.

Biomed Research International
|November 16, 2016
PubMed

Insights

Interdialytic weight gain (IDWG) showed a trend toward increasing blood pressure (BP) in pediatric hemodialysis (HD) patients. However, pre-dialysis hypertension may require management beyond fluid control, especially in non-anuric children.

Area of Science:

  • Pediatric Nephrology
  • Hypertension Management
  • Hemodialysis

Background:

  • Overhydration is a known factor in hypertension (HTN) for the hemodialysis (HD) population, though its association is debated.
  • Understanding the relationship between interdialytic weight gain (IDWG) and pre-dialysis blood pressure (BP) is crucial for pediatric patients.
  • Residual urine output (RUO) may influence fluid management and BP control in children undergoing HD.

Purpose of the Study:

  • To investigate the relationship between interdialytic weight gain (IDWG) and pre-hemodialysis (HD) blood pressure (BP) in pediatric patients.
  • To explore the influence of residual urine output (RUO) on this relationship.
  • To determine if IDWG is the sole factor contributing to pre-HD hypertension in this population.

Main Methods:

  • A 12-week study involving 5 pediatric patients (age 4-17) undergoing 170 HD sessions.
  • Patients were categorized into anuric (3 patients) and non-anuric (2 patients) based on residual urine output.
  • Blood pressure was assessed as systolic BP index (SBPI) and diastolic BP index (DBPI), normalized for age, height, and gender.

Main Results:

  • No significant difference in IDWG was observed between anuric and non-anuric patients (P > 0.05).
  • A positive, though not statistically significant, correlation was found between IDWG and both pre-HD SBPI (r = 0.833, P = 0.080) and pre-HD DBPI (r = 0.841, P = 0.074).
  • Pre-HD SBPI and DBPI were significantly higher in non-anuric patients compared to anuric patients (P < 0.001 and P < 0.01, respectively).

Conclusions:

  • Pre-dialysis hypertension in pediatric HD patients may not be solely attributable to interdialytic weight gain.
  • Therapeutic strategies beyond fluid management are likely necessary for effective hypertension control.
  • An individualized approach to managing hypertension is essential for pediatric dialysis patients, considering factors beyond fluid status.

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