P-043: Hypertension and end stage renal disease requiring hemodialysis.

BACKGROUND: The prevalence of hypertension (HT) remains high in hemodialysis patients ranging from 55% to 85%. Its origins are in the extracellular volume overload associated to the increased arterial resistance. The aim of our study was to describe the epidemiological, clinical and therapeutic characteristics in our hypertensive hemodialysis population.

METHODS: This was a cross-sectional descriptive study about 61 hemodialysis patients between May and August 2014. The collected data were age, type of initial renal disease, hemodialysis duration and treatment of HT.

RESULTS: Of these 61 patients undergoing hemodialysis, 58 were hypertensive when hemodialysis was started, 49 were hypertensive since the discovery of the initial renal disease, and 45 patients required antihypertensive treatment after at least 6 months of hemodialysis at the end of the study. The average age of hypertensive patients was 56 years (22-88 years). 36 patients were males. The mean duration of renal replacement therapy was 7.9 years (1-31 years). In patients who started hemodialysis with HT, the initial nephropathy was a glomerulopathy in 23 cases, including 15 cases of diabetic nephropathy, vascular nephropathy in 13 cases, tubulointerstitial in 10 cases (including 2 cases of polycystic kidney disease) and in 10 cases renal disease was indeterminate. Sixty patients used at least one antihypertensive treatment during their followed in renal replacement. Seventeen hemodialysis patients had left ventricular hypertrophy and 4 had presented an ischemic stroke.

CONCLUSIONS: Hypertension in chronic hemodialysis patients is common. Hypertension is a risk factor for cardiovascular disease which is the main cause of morbidity and mortality in the dialysis population. The extra-cellular volume expansion is the main pathophysiological determinant of hypertension in dialysis patients. To manage hypertension, limiting dietary intake, and individualizing dialysate sodium delivery would be the first steps. Antihypertensive drug therapies can effectively reduce blood pressure and are needed by the vast majority of hemodialysis patients.