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Published on: October 2, 2020
Comparison of Chronic Hemodialysis Patients under Strict Volume Control with respect to Cardiovascular Disease
Fadime Ersoy Dursun1, Ali Ihsan Gunal2, Ercan Kirciman1
1Firat University School of Medicine, Department of Internal Medicine, Elazig, Turkey.
Insights
Nondipper status in chronic hemodialysis patients is linked to increased cardiovascular risk, including cardiac hypertrophy and reduced left ventricle function. Strict volume control alone is insufficient if nocturnal blood pressure dipping is absent.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Research
Background:
- Cardiovascular disease (CVD) is a major concern in chronic hemodialysis (CHD) patients.
- The impact of nocturnal blood pressure patterns (dipping status) and fluid management on CVD in normotensive dialysis patients requires further investigation.
Purpose of the Study:
- To investigate the effects of strict volume control and nondipper status on cardiovascular disease markers in normotensive chronic hemodialysis patients.
- To analyze the association between nondipper status and cardiac structure/function, and vascular changes.
Main Methods:
- An observational, cross-sectional study involving 62 normotensive CHD patients without antihypertensive medication.
- Measurements included ambulatory blood pressure monitoring (ABPM), echocardiography for left ventricular mass index (LVMI), ultrasound for common carotid artery intima-media thickness (CIMT), and bioimpedance analysis for body fluids.
Main Results:
- Nondippers exhibited significantly higher 48-hour and nocturnal blood pressure compared to dippers.
- Nondippers showed increased extracellular fluid volume, higher LVMI, interventricular septum thickness, and CIMT, along with lower left ventricle ejection fraction (LVEF).
- Logistic regression indicated significantly higher odds of nocturnal hypertension in nondippers.
Conclusions:
- Nondipping pattern is independently associated with cardiac hypertrophy and reduced LVEF in normotensive dialysis patients.
- Strict volume control alone is insufficient to mitigate cardiovascular risk if nocturnal blood pressure dipping is not achieved.
- Monitoring dipping status is crucial for assessing and managing cardiovascular risk in hemodialysis patients.
Background:
The objective of this study was to determine the effects of strict volume control and nondipper situation on cardiovascular disease in chronic hemodialysis patients.
Methods:
This study is an observational and cross-sectional study including 62 patients with normotensive chronic hemodialysis using no antihypertensive drugs. A series of measurements including ambulatory blood pressure monitoring, left ventricular mass index by echocardiography, common carotid artery intima-media thickness by ultrasound, and body fluids by bioimpedance analysis were conducted for all subjects.
Results:
The patients were divided into two groups as dippers and nondippers according to their ambulatory blood pressure monitoring results. Average 48 h systolic, diastolic, and mean arterial blood pressure and nocturnal systolic, diastolic, and mean arterial blood pressure were significantly different between the dipper and nondipper groups (p<0.05). Before and after dialysis, extracellular fluid/intracellular fluid and extracellular fluid/dry body weight ratios were significantly higher in the nondipper group. Left ventricle mass index and interventricular septum thickness were significantly higher in the nondipper group (p<0.05). Left ventricle ejection fraction was significantly lower and common carotid artery intima-media thickness was higher in the nondipper group with a statistical significance (p<0.05). A two-predictor logistic model was fitted to the data to predict the comparability of dippers and nondippers.
Conclusion:
According to logistic regression analysis, the odds ratio for daytime diastolic blood pressure indicates that nondippers are 0.45 times more likely to have high blood pressure than dippers in daytime. But in night time, nondippers are about 2.55 times more likely to have high blood pressure comparing to dippers. An important finding of this study is that nondipping pattern is associated with cardiac hypertrophy and lower left ventricle ejection fraction in dialysis of patients with no hypertension. The results also suggest that applying strict volume control to achieve a normal blood pressure alone is not sufficient to reduce the risk of cardiovascular morbidity and mortality if the patients do not have a dipper status of nocturnal blood pressure.
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