Influences of Dry Weight Adjustment Based on Bioimpedance Analysis on Ambulatory Blood Pressure in Hemodialysis Patients

Jung-Ho Shin; Chae Rim Kim; Moonki Hong; Su Hyun Kim; Suk-Hee Yu

doi:10.5646/jksh.2012.18.4.166

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Shin, Kim, Hong, Kim, and Yu: Influences of Dry Weight Adjustment Based on Bioimpedance Analysis on Ambulatory Blood Pressure in Hemodialysis Patients

Original Article

Journal of the Korean Society of Hypertension

Journal of the Korean Society of Hypertension 2012; 18(4): 166-175.

Published online: 31 December 2012

DOI: https://doi.org/10.5646/jksh.2012.18.4.166

Influences of Dry Weight Adjustment Based on Bioimpedance Analysis on Ambulatory Blood Pressure in Hemodialysis Patients

Jung-Ho Shin, MD, Chae Rim Kim, MD, Moonki Hong, MD, Su Hyun Kim, MD, Suk-Hee Yu, MD

Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.

Corresponding author (shyu3cau@gmail.com)

Received 1 December 2012 Revised 26 December 2012 Accepted 26 December 2012

Abstract

Background

Hypertension is a common problem for hemodialysis patients and is associated with an increased cardiovascular mortality. We analyzed ambulatory blood pressure (ABP) in hemodialysis patients and investigated if an adjustment of dry weight can be used to control blood pressure.

Methods

ABP was measured for twenty-four hours after hemodialysis. A bioimpedance Analysis (BIA) was conducted. Patients were divided into two groups by the edema index. A normohydration (NH) group included patients with the edema index less than 0.40, and an overhydration (OH) group included patients with the edema index 0.40 or more. We accordingly adjusted the dry weight based on BIA results.

Results

Thirty-six patients were recruited, comprising twenty-two men and fourteen women. In regard to the ABP, 24-hour systolic and diastolic blood pressures were 140.2 ± 19.7 mm Hg and 79.0 ± 10.6 mm Hg, respectively. There was a significant association between 24-hour systolic blood pressure and the edema index (r = 0.501, p = 0.002). Twenty four-hour systolic blood pressure was significantly different between the NH and OH groups (median value, 132.0 vs. 150.5 mm Hg; p = 0.008). In OH group, after adjustment of the dry weight, the edema index was decreased from 0.411 ± 0.009 to 0.389 ± 0.047 and office systolic blood pressure was also decreased from 144.7 ± 32.7 mm Hg to 125.3 ± 15.4 mm Hg in OH group (p = 0.028 and p = 0.018, respectively).

Conclusions

The edema index obtained by the bioimpedance analysis is significantly correlated with 24-hour systolic blood pressure in hemodialysis patients. Also, an adjustment of dry weight can be used to control blood pressure in hemodialysis patients.

Keywords: Ambulatory blood pressure monitoring, Renal dialysis, Hypertension

Figures and Tables

Fig. 1

Relationship between 24-hour blood pressure and edema index. This shows that 24-hour systolic blood pressure is significantly correlates with edema index (A), however, 24-hour diastolic blood pressure is not correlates with edema index (B). ^*p < 0.05.

Fig. 2

Differences of 24-hour systolic blood pressure and brain natriuretic peptide (BNP) level between normohydration (NH) group and overhydration (OH) group. 24-hour systolic blood pressure in OH is significantly higher than that in NH (A), but BNP level is not statistically different between two groups (B). ^*p < 0.05.

Table 1

Baseline characteristics

Values are presented as mean ± standard deviation or number (%).

BP, blood pressure.

Table 2

Differences between NH group and OH group

Values are presented as mean ± standard deviation or number (%).

NH, normohydration; OH, overhydration; BP, blood pressure; BNP, brain natriuretic peptide; ECW, extracellular water; TBW, total body water.

Table 3

Changes after dry weight adjustment for six months in NH group and OH group

Values are presented as mean ± standard deviation.

NH, normohydration; OH, overhydration; BP, blood pressure; BNP, brain natriuretic peptide; ECW, extracellular water; TBW, total body water.

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