Control of hypertension and prolonged survival on maintenance hemodialysis

52 patients started dialysis in our center prior to 1971. When this study ended in December 1980, 8 patients had been lost to follow-up, and 7 had died, none of stroke or myocardial infarction. The overall actuarial survival rate was 85% at 10 years. For all patients treatment consisted of a long (24-30h/week) slow hemodialysis on standard Kiil dialysers throughout the 10 years. Good blood pressure (BP) control was achieved by a strict maintenance of dry weight alone (low salt diet, but no antihypertensive drug), even in 12 patients dialyzing only twice a week. This population remained completely free of both myocardial infarctions and cerebrovascular accidents. This experience suggests that if BP is well controlled, accelerated atherosclerosis is not the inevitable complication of long-term hemodialysis. The authors believe that the long, slow dialysis technique they use is the key to the good BP control achieved uniformly in this series.