Treatment of severe hypertension in chronic renal failure by haemofiltration

Thirteen patients with chronic renal insufficiency who had been transferred from haemodialysis to haemofiltration treatment because of dialysis and drug resistant hypertension (10 with high plasma renin activity) showed normalisation of blood pressure during a treatment period of 8 months, after which only one patient required antihypertensive drug therapy. During the first period blood pressure drop paralleled body weight loss and after 3--4 weeks blood pressure remained normal in spite of an increase in body weight. In the course of the second phase the effect of fluid withdrawal on blood pressure was directly proportional to the blood pressure at the beginning of the procedure. Adaptation of baroreceptor function must be assumed. In contrast to haemodialysis, haemofiltration did not influence the inulin space. Because of the reduced removal of small molecular substances compared with haemodialysis, extracellular osmolarity was kept stable during haemofiltration. Withdrawal of even large amounts of fluid was sustained without collapse reactions or signs of orthostatic dysregulation.