Intensive hemodialysis improves blood pressure control and reduces need for antihypertensive agents

Persistent hypertension is a vexing problem in the care of dialysis patients.¹ Perennially, blood pressures over 140/90 are the second leading cause of kidney failure in the U.S.² Antihypertensive medications are widely used and polypharmacy is common, but pharmacologic intervention is often unsuccessful at lowering blood pressure to normotensive levels.³

Trials have shown intensive hemodialysis reduces blood pressure

• In the Daily Trial of the Frequent Hemodialysis Network, intensive hemodialysis reduced pre-dialysis systolic blood pressure (SBP) by 7.7 mmHg, relative to three sessions per week.⁴
• In the Nocturnal Trial of the Frequent Hemodialysis Network, intensive hemodialysis reduced pre-dialysis SBP by 7.3 mmHg, relative to three sessions per week, a finding also reported in an earlier Canadian trial.^4,5

Trials and prospective cohort studies alike have shown that intensive hemodialysis reduces the need for antihypertensive medications

• Both intensive schedules in the Frequent Hemodialysis Network reduced antihypertensive medication use, relative to three sessions per week.⁴
• In the Following Rehabilitation, Economics, and Everyday Dialysis Outcomes Measurements (FREEDOM) Study of short daily hemodialysis, the mean number of prescribed antihypertensive agents decreased from 1.7 to 1.0 in one year, while the percentage of patients not prescribed antihypertensive agents increased from 21% to 47%.⁶

Conclusion

Multiple randomized and prospective cohort studies demonstrate that intensive hemodialysis significantly lowers pre-dialysis blood pressure and reduces the need for antihypertensive medications. By lowering blood pressure, intensive hemodialysis may improve cardiovascular outcomes.