Dry-weight reduction in hypertensive hemodialysis patients (DRIP): A randomized, controlled trial

Rajiv Agarwal, Pooneh Alborzi, Sangeetha Satyan, Robert P. Light

Research output: Contribution to journalArticle

218 Citations (Scopus)

Abstract

Volume excess is thought to be important in the pathogenesis of hypertension among hemodialysis patients. To determine whether additional volume reduction will result in improvement in blood pressure (BP) among hypertensive patients on hemodialysis and to evaluate the time course of this response, we randomly assigned long-term hypertensive hemodialysis patients to ultrafiltration or control groups. The additional ultrafiltration group (n= 100) had the dry weight probed without increasing time or duration of dialysis, whereas the control group (n=50) only had physician visits. The primary outcome was change in systolic interdialytic ambulatory BP. Postdialysis weight was reduced by 0.9 kg at 4 weeks and resulted in -6.9 mm Hg (95% CI: -12.4 to -1.3 mm Hg; P=0.016) change in systolic BP and -3.1 mm Hg (95% CI: -6.2 to -0.02 mm Hg; P=0.048) change in diastolic BP. At 8 weeks, dry weight was reduced 1 kg, systolic BP changed -6.6 mm Hg (95% CI: -12.2 to -1.0 mm Hg; P=0.021), and diastolic BP changed -3.3 mm Hg (95% CI: -6.4 to -0.2 mm Hg; P=0.037) from baseline. The Mantel-Hanzel combined odds ratio for systolic BP reduction of ≥10 mm Hg was 2.24 (95% CI: 1.32 to 3.81; P=0.003). There was no deterioration seen in any domain of the kidney disease quality of life health survey despite an increase in intradialytic signs and symptoms of hypotension. The reduction of dry weight is a simple, efficacious, and well-tolerated maneuver to improve BP control in hypertensive hemodialysis patients. Long-term control of BP will depend on continued assessment and maintenance of dry weight.

Original languageEnglish
Pages (from-to)500-507
Number of pages8
JournalHypertension
Volume53
Issue number3
DOIs
StatePublished - Mar 2009

Fingerprint

Renal Dialysis
Weight Loss
Randomized Controlled Trials
Blood Pressure
Weights and Measures
Ultrafiltration
Control Groups
Kidney Diseases
Health Surveys
Hypotension
Signs and Symptoms
Dialysis
Odds Ratio
Maintenance
Quality of Life
Hypertension
Physicians

Keywords

  • Ambulatory blood pressure
  • Hemodialysis
  • Hypertension
  • Ultrafiltration
  • Volume overload

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Dry-weight reduction in hypertensive hemodialysis patients (DRIP) : A randomized, controlled trial. / Agarwal, Rajiv; Alborzi, Pooneh; Satyan, Sangeetha; Light, Robert P.

In: Hypertension, Vol. 53, No. 3, 03.2009, p. 500-507.

Research output: Contribution to journalArticle

Agarwal, Rajiv ; Alborzi, Pooneh ; Satyan, Sangeetha ; Light, Robert P. / Dry-weight reduction in hypertensive hemodialysis patients (DRIP) : A randomized, controlled trial. In: Hypertension. 2009 ; Vol. 53, No. 3. pp. 500-507.
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abstract = "Volume excess is thought to be important in the pathogenesis of hypertension among hemodialysis patients. To determine whether additional volume reduction will result in improvement in blood pressure (BP) among hypertensive patients on hemodialysis and to evaluate the time course of this response, we randomly assigned long-term hypertensive hemodialysis patients to ultrafiltration or control groups. The additional ultrafiltration group (n= 100) had the dry weight probed without increasing time or duration of dialysis, whereas the control group (n=50) only had physician visits. The primary outcome was change in systolic interdialytic ambulatory BP. Postdialysis weight was reduced by 0.9 kg at 4 weeks and resulted in -6.9 mm Hg (95{\%} CI: -12.4 to -1.3 mm Hg; P=0.016) change in systolic BP and -3.1 mm Hg (95{\%} CI: -6.2 to -0.02 mm Hg; P=0.048) change in diastolic BP. At 8 weeks, dry weight was reduced 1 kg, systolic BP changed -6.6 mm Hg (95{\%} CI: -12.2 to -1.0 mm Hg; P=0.021), and diastolic BP changed -3.3 mm Hg (95{\%} CI: -6.4 to -0.2 mm Hg; P=0.037) from baseline. The Mantel-Hanzel combined odds ratio for systolic BP reduction of ≥10 mm Hg was 2.24 (95{\%} CI: 1.32 to 3.81; P=0.003). There was no deterioration seen in any domain of the kidney disease quality of life health survey despite an increase in intradialytic signs and symptoms of hypotension. The reduction of dry weight is a simple, efficacious, and well-tolerated maneuver to improve BP control in hypertensive hemodialysis patients. Long-term control of BP will depend on continued assessment and maintenance of dry weight.",
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