الفهرس 
Epidemiology & pathogenesis of Hypertension in Hemodialysis populationOnly 14 pages are availabe for public view
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Abstract
Cardiovascular mortality represents the leading cause of death in ESRD maintained on regular HD. HTN highly prevalent among maintenance HD patients and increasing annually; however, it still represents complex issue in hemodialysis practice and only a minority has adequate control due to multifactorial pathogenesis in addition to absence of strict definition & tool for hypertension diagnosis in those patients.
Volume overload and sodium retention are the major pathogenic mechanism of HTN in ESRD as the excretory function is severely impaired even with some preserved residual renal function. HD is a potent tool to remove excess sodium and water, thus, strategies that involve longer HD sessions & strict dietary sodium control are associated with better BP control and reduction in HTN prevalence.
The duration of dialysis session and UFR are associated with the incidence of IDH that interferes with HD adequacy through decreased HD tolerability. The longer dialysis sessions allow for slower UFR and tolerance of greater fluid removal, leading to improved control of hypertension.
The current work is observational study, 50 adult, prevalent, hypertensive HD patients recruited from Manshyia El Bakry General Hospital were included. Patients were divided into two groups according to HD session duration: group A included 25patients who received 4.5 hour HD session duration, and group B included 25 patients who received the usual 4 hours HD session duration.
They were observed for six months for changes in BP before and after sessions, UF volume changes and laboratory results that included CBC, URR and Ca-P product.
All participants were subjected to full history taking including drug history and etiology of renal disease and thoroughly clinical examination as well.
Patients in both groups were age matched with the mean age is 51.16±10.60 & 51.12±11.52for group A& B, respectively. Males represented 64% & 56% of patients for group A& B, respectively. They were maintained on maintenance HD therapy for 4.52± 2.16 & 5.44± 2.74 years for group A& B, respectively, majorly through an AVF (86&92% for group A&B, respectively). HTN was the most frequent reported etiology of renal failure in both groups (48% in group A and 40% in group B).
Our results showed statistically significant decline as regard UF volume with longer HD session regimen after 6th month of follow up compared to 1st month value in group A, p-value < 0.001.
Longer HD regimen was associated with statistically significant decline of mean SBP after HD session compared to pre-dialysis values, p-value < 0.001.
Statistically significant decline is observed with longer duration HD session after 6 month of follow up period as regard pre-dialysis SBP, p-value < 0.001, as well as post-dialysis SBP, p-value < 0.001.
However, longer HD session was associated with statistically significant higher degree of decline in the favor of pre-dialysis SBP compared to mean difference in post-dialysis SBP, p-value 0.024.
The degree of decline in mean SBP was significantly higher in the favor of longer HD session, group A, compared to patients received the usual HD session duration, group B, at 1st month of follow up period, p-value 0.025.
As regard both predialysis & postdialysis SBP, the degree of decline was higher in the favor of longer duration HD, group A, compared to the usual regimen, group B.
The present study showed highly significant reduction as regard mean DBP after HD session compared to predialysis values in patients received longer HD session, group A, at 1st month, p-value < 0.001, and after 6th month of follow up, p-value < 0.001.
The degree of decline in mean DBP is significantly higher in patients received longer HD session, group A, compared to those received conventional HD, group B, at 1st month of follow up, p-value < 0.001, and after 6 month of follow up, p-value 0.002.
As regard perdialysis DBP, highly significant decline is associated with longer HD, group A, after 6 month of follow up, P-value < 0.001.
Also a significant decline is observed as regard postdialysis DBP after 6 month of longer HD, group A,
P-value 0.009.
The degree of decline as regard predialysis DBP was higher with longer HD, group A, compared to usual HD regimen, group B.
As regard postdialysis DBP, the degree of decline was statistically significant in patients received longer HD session, group A, p-value <0.001 compared to insignificant reduction in those received usual HD regimen group B, P-value 0.061.