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Yu J, Chen X, Li Y, Wang Y, Liu Z, Shen B, Teng J, Zou J, Ding X. Paradoxical Association Between Intradialytic Blood Pressure Change and Long-Term Mortality with Different Levels of Interdialytic Weight Gain. Int J Gen Med 2021; 14:211-220. [PMID: 33505169 PMCID: PMC7829598 DOI: 10.2147/ijgm.s288038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/30/2020] [Indexed: 12/12/2022] Open
Abstract
Background A greater interdialytic weight gain (IDWG) implies a greater ultrafiltration rate, which might lead to hemodynamic instability and intradialytic blood pressure (BP) change in hemodialysis patients. However, current studies have not explicated the impact of IDWG on the association between intradialytic BP changes and prognosis, especially in patients without cardiac dysfunction and diabetes. In this study, we aimed to explore the relationship between absolute intradialytic BP changes and mortality with different IDWG levels. Methods A total of 204 hemodialysis patients (without cardiac dysfunction and diabetes) were included in this prospective observation study, with a mean follow-up of 55.32±20.99 months. Initially, we collected IDWG, IDWG% (percentages according to dry weight), and pre-/post-BPs of 36 consecutive dialysis sessions during three months enrollment. And the average value of them was defined as baseline value. Patients were divided into 3 cohorts according to IDWG% tertiles (<3.3%, 3.3%-4.6%, ≥4.6%). Comparisons between different tertiles were analyzed. Results Compared to the low IDWG% group (tertile 1, T1), patients of high IDWG% group (tertile 3, T3) were younger, had higher ultrafiltration rate, less residual kidney function, lower BMI and dry weight, longer dialysis vintage and higher N terminal pro B type natriuretic peptide levels (P<0.05). Correlations were found between IDWG% and intradialytic BP changes. Kaplan-Meier analysis and multivariate Cox regression model adjusted for demographic data, dialysis information and predialysis BPs indicated that greater absolute intradialytic BP changes were associated with worse prognosis in T1 group (P<0.05). While in T3 group, less absolute intradialytic BP changes were associated with higher mortality (P<0.05). Conclusion There is a paradoxical association between absolute intradialytic BP changes and long-term mortality with different IDWG levels. Both BP stability and volume balance are crucial to patients' prognosis.
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Affiliation(s)
- Jinbo Yu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Xiaohong Chen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Yang Li
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Yaqiong Wang
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Zhonghua Liu
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Bo Shen
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Jie Teng
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Jianzhou Zou
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
| | - Xiaoqiang Ding
- Division of Nephrology, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, People's Republic of China.,Shanghai Institute of Kidney Disease and Dialysis, Shanghai, People's Republic of China.,Shanghai Key Laboratory of Kidney and Blood Purification, Shanghai, People's Republic of China
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Kara B. Health Beliefs Related to Salt-Restricted Diet and Associated Factors in Turkish Patients on Hemodialysis. J Transcult Nurs 2018; 29:155-164. [DOI: 10.1177/1043659617691577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Purpose: To examine health beliefs related to salt-restricted diet, to investigate their associations with demographic/disease-related characteristics and family support, and to determine the need for tailored interventions in Turkish patients on hemodialysis. Method: A cross-sectional study was conducted among 200 patients on hemodialysis. Data were collected through an information form, the Perceived Social Support from Family Scale and the Beliefs about Dietary Compliance Scale, including two subscales: perceived benefits and barriers. Descriptive statistics, Student’s t test, Pearson’s correlation coefficients, and linear regression analysis were used for data analysis. Results: The item mean perceived benefit score was higher than the item mean perceived barrier score. Limiting salt intake, family support, and the presence of residual urine output were associated with health beliefs. Conclusions/Implications: The likelihood of adherence to salt-restricted diet was high. A better understanding of health beliefs about salt-restricted diet and their related factors may facilitate the implementation of tailored interventions.
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Aftab RA, Khan AH, Adnan AS, Sulaiman SAS, Khan TM. Safety and Efficacy of Losartan 50 mg in Reducing Blood Pressure among Patients with Post-Dialysis Euvolemic Hypertension: A Randomized Control Trial. Sci Rep 2017; 7:17741. [PMID: 29255272 PMCID: PMC5735086 DOI: 10.1038/s41598-017-17437-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/27/2017] [Indexed: 11/29/2022] Open
Abstract
The aim of current study was to assess the effectiveness of losartan 50 mg in reducing blood pressure among post-dialysis euvolemic hypertensive patients, observing their survival trends and adverse events during the course of study. A multicentre, prospective, randomised, single-blind trial was conducted to assess the effect of losartan 50 mg every other day (EOD), once a morning (OM) among post-dialysis euvolemic hypertensive patients. Post-dialysis euvolemic assessment was done by a body composition monitor (BCM). Covariate Adaptive Randomization was used for allocation of participants to the standard or intervention arm. Of the total 229 patients, 96 (41.9%) were identified as post-dialysis euvolemic hypertensive. Final samples of 88 (40.1%) patients were randomized into standard and intervention arms. After follow-up of 12 months’ pre-dialysis systolic (p < 0.001) and diastolic (p 0.01), intradialysis diastolic (p 0.02), post-dialysis systolic (p < 0.001) and diastolic (p < 0.001) blood pressure was reduced from the baseline among intervention-arm patients Compared to only pre-dialysis systolic blood pressure (p 0.003) among standard arm patients after 12 months of follow. Total of six deaths were reported among standard-arm patients compared to 2 deaths among the intervention arm. Losartan 50 mg achieve an overall significant decline in blood pressure among post-dialysis euvolemic hypertensive patients.
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Affiliation(s)
- Raja Ahsan Aftab
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia. .,CKD Resource Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia.
| | - Azreen Syazril Adnan
- CKD Resource Centre, School of Medical Sciences, Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
| | - Syed Azhar Syed Sulaiman
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences Universiti Sains Malaysia, 11800, Gelugor, Penang, Malaysia
| | - Tahir Mehmood Khan
- School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway, 45700, Selangor, Malaysia.,Department of Pharmacy, Abasyn University, Peshawar, Pakistan
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