title: Readmissions related to antihypertensive medications used in chronic hemodialysis.
abstract: BACKGROUND
  In hemodialysis, hypertension is treated by removing excess fluid and antihypertensive therapy. Commonly, the antihypertensives used to treat hypertension in earlier stages of kidney disease are continued as the patient progresses into end-stage renal disease and begins dialysis, without much evidence for benefit.
  
  
  METHODS
  This study is a single center, retrospective chart review that included hemodialysis patients admitted for congestive heart failure (CHF), fluid overload, or pulmonary edema as determined by ICD-9 code (428.x, 276.6, 518.4, 506.1). The primary objective was to determine if the number or class of antihypertensives used in the chronic hemodialysis population increased the number of readmissions related to CHF, fluid overload, or pulmonary edema. Patients were separated into two groups based on total number of antihypertensive medications, less than or equal to 2 medications for group 1 and greater than two medications for group 2. The primary endpoint was 30-day readmission for CHF, fluid overload, or pulmonary edema.
  
  
  RESULTS
  For the study period, 85 individual patient charts met inclusion criteria. Group 1 (n = 44) experienced seven readmissions (16%) and group 2 (n = 41) experienced eight readmissions (18%) (p = 0.663). The most common antihypertensives at discharge were ACE inhibitors for group 1 (45%) and dihydropyridine calcium channel blockers for group 2 (66%). No difference in systolic blood pressures before, during and after hemodialysis was found between groups.
  
  
  CONCLUSIONS
  Antihypertensive medications continue to play an important role in the hemodialysis population. This study suggests that drug class and quantity of antihypertensives do not alter readmission rate in the setting of fluid overload.
authors.affiliation: a College of Pharmacy, University of Arizona , Tucson , AZ , USA .|b Banner University Medical Center , Tucson , AZ , USA .
authors.forename: Marcella N
authors.initials: MN
authors.lastname: Honkonen
authors.affiliation: c Walgreens Pharmacy , Tucson , AZ , USA , and.
authors.forename: Patrick
authors.initials: P
authors.lastname: McNeill
authors.affiliation: d Arizona Poison and Drug Information Center , Tucson , AZ , USA.
authors.forename: Alex
authors.initials: A
authors.lastname: Jasensky
authors.affiliation: a College of Pharmacy, University of Arizona , Tucson , AZ , USA .|b Banner University Medical Center , Tucson , AZ , USA .
authors.forename: Brian L
authors.initials: BL
authors.lastname: Erstad
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D005260:Female; D006333:Heart Failure / Q000209:etiology; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D011654:Pulmonary Edema / Q000209:etiology; D006435:Renal Dialysis; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents
keywords: Antihypertensive; fluid overload; hemodialysis; hypertension; readmission