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Abstract: FR-PO356

Effects of a Comprehensive Volume Reduction Protocol on Hydration Status and Blood Pressure Control in Hemodialysis Patients

Session Information

Category: Hypertension and CVD

  • 1402 Hypertension and CVD: Clinical, Outcomes, and Trials

Authors

  • Wilund, Ken, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
  • Perez, Luis M., University of Illinois, Urbana, Illinois, United States
  • Burrows, Brett, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
  • Harris, Alana Pauline, University of Illinois at Urbana-Champaign, Urbana, Illinois, United States
  • Barnes, Jennifer L., Illinois State University, Normal, Illinois, United States
  • Chan, Lauren, Oregon State University, Tigard, Oregon, United States
Background

Chronic volume overload remains one of the most vexing problems in hemodialysis (HD) therapy. The purpose of this study was to investigate the impacts of comprehensive volume reduction protocol focused on reducing dietary sodium intake, blood pressure medications, and post-dialysis weight, on HD patient’s hydration status and blood pressure.

Methods

Twenty-three maintenance HD patients (age = 56 ± 13.3y, 48% female) completed a 6-month comprehensive volume control protocol consisting of: 1) weekly intradialytic counseling to reduce dietary sodium intake and interdialytic weight gain (IDWG); 2) persistent reductions in post-dialysis weight; and 3) reductions in prescribed blood pressure (BP) medications. The primary outcome was volume overload (VO) measured by bioelectrical impedance spectroscopy. Secondary outcomes included: IDWG, estimated dry weight (EDW), BP, BP medication prescriptions, and dietary sodium intake.

Results

From baseline (BL) to 6 months (6m), significant improvements were noted in VO (BL 3.9 ± 3.9L (BL) vs 6m 2.6 ± 3.4L, p=0.003), post-dialysis weight (BL 89.4 ± 23.1 kg vs 6m 87.6± 22.2 kg; p = 0.012), and EDW (BL 89.0 ± 23.2 vs 6m 86.7 ± 22.5 kg., p=0.009). There was also a trend for a reduction in monthly averaged IDWG (p = 0.053), and dietary sodium intake (BL 2.9 ± 1.6 vs 6m 2.3 ± 1.1 g/day, p=0.13). Neither systolic BP (BL 160 ± 25 vs. 6m 156 ± 23 mmHg, p=0.56) nor diastolic BP (BL 81 ± 20 vs 6m 79 ± 15 mmHg, p= 0.73) changed, though there was a significant reduction in the total number of BP medications prescribed (BL 3.0 ± 1.0 vs 6m 1.5 ± 1.0 BP meds; p<0.01).

Conclusion

Our comprehensive volume reduction protocol significantly improved HD patient’s hydration status. While BP did not change, the reduction in prescribed BP medication number suggests improved BP control. Despite these overall positive findings, the magnitude of change in most variables was modest, and cultural changes in hemodialysis clinics may be necessary to realize more robust results.

Funding

  • Commercial Support