title: Improvement of resistant hypertension by nocturnal hemodialysis in a patient with end-stage kidney disease.
abstract: Resistant hypertension is a common and refractory complication of hemodialysis (HD) patients and is associated with a higher risk of cardiovascular morbidity and mortality. Here we present a case of resistant hypertension treated successfully by nocturnal HD. A 63-year-old female with end-stage kidney disease was hospitalized for severe headache, objective vertigo and persistent vomiting for 1 month on February 6, 2012. She had been on intermittent HD for 3 months, and her blood pressure maintained 200-240/100-130 mm Hg even after using 7 kinds of antihypertensive drugs including olmesartan, benazepril, nitrendipine, arotinolol, terazosin, clonidine and torasemide. A CT of the abdomen revealed a mild hyperplasia of the left adrenal gland (fig. 1). However, plasma renin, angiotensin and aldosterone were all within the normal range. Nocturnal extended HD was initiated with a blood flow rate of 150 ml/min and a dialysis time of 7 h. After 3 months of nocturnal HD, all symptoms were relieved and her systolic blood pressure started to decrease by 10-20 mm Hg. Six months later, the predialysis blood pressure was decreased to 140-160/90-100 mm Hg and the antihypertensive drugs were reduced to 4 kinds. Meanwhile, the blood biochemical parameters including hemoglobin, serum calcium, phosphate and parathyroid hormone were all controlled well during 2 years of treatment. This case indicates that nocturnal extended HD is probably a promising and effective choice for resistant hypertension in HD patients.
authors: Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, PR China.
authors: Xiaojing
authors: X
authors: Tang
authors: Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, PR China.
authors: Xiaohong
authors: X
authors: Hu
authors: Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, PR China.
authors: Changlin
authors: C
authors: Mei
authors: Division of Nephrology, Shanghai Changzheng Hospital, Second Military Medical University, Shanghai, PR China.
authors: Shengqiang
authors: S
authors: Yu
keywords: End-stage kidney disease; Nocturnal hemodialysis; Resistant hypertension