Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP) A Randomized, Controlled Trial
Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP) A Randomized, Controlled Trial
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DOI：
10.1161/hypertensionaha.108.125674
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发表时间：
2009-03-01
期刊：
影响因子：
8.3
通讯作者：
Light, Robert P.
中科院分区：
文献类型：
--
作者：
Agarwal, Rajiv;Alborzi, Pooneh;Light, Robert P.
血容量过多被认为是血液透析患者高血压的重要发病机制。为了确定额外的容量减少是否会导致血液透析高血压患者的血压（BP）改善，并评估这种反应的时间过程，我们将长期高血压血液透析患者随机分配到超滤组或对照组。额外超滤组（n=100）在不增加透析时间或持续时间的情况下探测干重，而对照组（n=50）仅进行医生访视。主要结果是透析间期动态血压的变化。透析后体重在第4周降低0.9 kg，导致收缩压变化-6.9 mmHg（95% CI：-12.4至-1.3 mmHg; P=0.016），舒张压变化-3.1 mmHg（95% CI：-6.2至-0.02 mmHg; P=0.048）。第8周时，干体重降低1 kg，收缩压较基线变化-6.6 mmHg（95% CI：-12.2至-1.0 mmHg; P=0.021），舒张压较基线变化-3.3 mmHg（95% CI：-6.4至-0.2 mmHg; P=0.037）。收缩压降低≥ 10 mm Hg的Mantel-Hanzel联合优势比为2.24（95%CI：1.32 - 3.81; P=0.003）。尽管透析中低血压体征和症状增加，但在肾脏疾病生活质量健康调查的任何领域均未观察到恶化。降低干体重是一种简单、有效、耐受性良好的改善高血压血液透析患者血压控制的方法。BP的长期控制将取决于持续评估和保持干重。（高血压。2009;53：500-507.）
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. (Hypertension. 2009;53:500-507.)