Document Detail

Why is there significant overlap in volume status between hypertensive and normotensive patients on dialysis?
MedLine Citation:
PMID:  18204249     Owner:  NLM     Status:  MEDLINE    
BACKGROUND/AIM: Volume overload is believed to play a pivotal role in the pathogenesis of hypertension in dialysis patients. Although the extracellular water (ECW) content in hypertensive dialysis patients was significantly higher than in normotensive dialysis patients on the whole, there was considerable overlap in ECW between the two groups. Little is known about the hemodynamic characteristics in subgroups of patients with normotension but a high volume (HV) status or with hypertension but a normal volume (NV) status. We investigate the overlap in ECW between controlled and uncontrolled hypertension in dialysis patients. METHODS: Fifty-two patients (mean age 62 years, 26 males and 26 females) on peritoneal dialysis were enrolled into this study. The ECW was assessed by bioimpedance analysis and normalized by individual height in meters (NECW). The mean value of NECW in both sexes was arbitrarily set to define NV status (lower than mean value) or HV status (higher than mean value). All patients were thus divided into four subgroups: controlled hypertension with NV (CHT-NV), controlled hypertension with HV (CHT-HV), uncontrolled hypertension with NV (UHT-NV) and uncontrolled hypertension with HV (UHT-HV). The stroke volume, cardiac output and total peripheral resistance were echocardiographically measured and their respective indices were calculated. RESULTS: There were 12 (23%), 8 (15%), 14 (27%) and 18 (35%) patients in the CHT-NV, CHT-HV, UHT-NV and UHT-HV subgroups, respectively. The four subgroups were matched for sex, diabetes and age. The NECW in the CHT-HV group was higher than that in CHT-NV and UHT-NV groups (p < 0.01), but was comparable with that in the UHT-HV group. The stroke volume and cardiac output indices in the CHT-HV group were not significantly different from those in the CHT-NV and UHT-NV groups. The total peripheral resistance index in the CHT-HV group was lower than that in UHT-NV and CHT-NV groups (p < 0.05), but was comparable to that in the UHT-HV group. There was no difference in heart rate among the four groups. CONCLUSIONS: The overlap in ECW between controlled hypertension and uncontrolled hypertension in dialysis patients was related to a significant difference in total peripheral resistance index, but not to significant differences in stroke volume and cardiac output indices. The CHT-HV patients were characterized by lower total peripheral resistance indices.
Li-Tao Cheng; Jun-Ping Tian; Li-Jun Tang; Hui-Min Chen; Yue Gu; Feng-He Du; Tao Wang
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-01-18
Journal Detail:
Title:  American journal of nephrology     Volume:  28     ISSN:  1421-9670     ISO Abbreviation:  Am. J. Nephrol.     Publication Date:  2008  
Date Detail:
Created Date:  2008-04-08     Completed Date:  2008-06-23     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8109361     Medline TA:  Am J Nephrol     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  508-16     Citation Subset:  IM    
Copyright Information:
(c) 2008 S. Karger AG, Basel.
Division of Nephrology, Peking University Third Hospital, Beijing, China.
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MeSH Terms
Blood Pressure / physiology*
Body Water / physiology*
Heart Ventricles / pathology
Hemodynamics / physiology*
Hypertension / complications,  pathology,  physiopathology*
Hypertrophy, Left Ventricular / etiology,  pathology
Kidney Failure, Chronic / complications,  physiopathology,  therapy
Middle Aged
Renal Dialysis*
Vascular Resistance / physiology

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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