Towards improved cardiovascular management: the necessity of combining blood pressure and fluid overload.
BACKGROUND
Hypertension and fluid overload (FO) are well-recognized problems in the chronic kidney disease (CKD) population. While the prevalence of hypertension is well documented, little is known about the severity of FO in this population.


METHODS
A new bioimpedance spectroscopy device (BCM-Body Composition Monitor) was selected that allows quantitative determination of the deviation in hydration status from normal ranges (DeltaHS). Pre-dialysis systolic blood pressure (BPsys) and DeltaHS was analysed in 500 haemodialysis patients from eight dialysis centres. A graphical tool (HRP-hydration reference plot) was devised allowing DeltaHS to be combined with measurements of BPsys enabling comparison with a matched healthy population (n = 1244).


RESULTS
Nineteen percent of patients (n = 95) were found to have normal BPsys and DeltaHS in the normal range. Approximately one-third of patients (n = 133) exhibited reasonable control of BPsys and fluids (BPsys <150 mmHg and DeltaHS <2.5 L). In only 15% of patients (n = 74) was hypertension observed (BPsys >150 mmHg) with a concomitant DeltaHS >2.5 L (possible volume-dependent hypertension). In contrast, 13% of patients (n = 69) were hypertensive with DeltaHS <1.1 L (possible essential hypertension). In 10% of patients (n = 52), BPsys <140 mmHg was recorded despite DeltaHS exceeding 2.5 L.


CONCLUSIONS
Our study illustrated the wide variability in BPsys regardless of the degree of DeltaHS. The HRP provides an invaluable tool for classifying patients in terms of BPsys and DeltaHS and the proximity of these parameters to reference ranges. This represents an important step towards more objective choice of strategies for the optimal treatment of hypertension and FO. Further studies are required to assess the prognostic and therapeutic role of the HRP.
Wabel
Peter
P
Research & Development, Fresenius Medical Care D GmbH, Daimlerstrasse 15, D-61352 Bad Homburg, Germany. peter.wabel@fmc-ag.com
Moissl
Ulrich
U
Chamney
Paul
P
Jirka
Tomas
T
Machek
Petr
P
Ponce
Pedro
P
Taborsky
Petr
P
Tetta
Ciro
C
Velasco
Nestor
N
Vlasak
Jiri
J
Zaluska
Wojciech
W
Wizemann
Volker
V
D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D005260:Female; D005440:Fluid Therapy; D006801:Humans; D006973:Hypertension / Q000453:epidemiology / Q000517:prevention & control*; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000379:methods