Short Daily versus Conventional Hemodialysis for Hypertensive Patients: A Randomized Cross-Over StudyReport as inadecuate

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Treatment of end stage renal disease patients with short daily hemodialysis has been associated with an improvement in blood pressure. It is unclear from these studies if anti-hypertensive management had been optimized prior to starting short daily hemodialysis. Also, the potential mechanisms of blood pressure improvement remain to be fully elucidated.

Study Design, Setting and Participants

We undertook a randomized cross-over trial in adult hypertensive patients with ESRD treated with conventional hemodialysis to determine: 1 if short-daily hemodialysis is associated with a reduction in systolic blood pressure after a 3-month blood pressure optimization period and; 2 the potential mechanisms of blood pressure reduction. Blood pressure was measured using Canadian Hypertension Education Program guidelines. Extracellular fluid volume ECFV was assessed with bioimpedance. Serum catecholamines were used to assess the sympathetic nervous system. Interleukin-6 IL-6 and thiobarbituric acid reactive substances T-BARS were used as markers of inflammation and oxidative stress respectively.


After a 3-month run-in phase in which systolic blood pressure improved, there was no significant difference in pre-dialysis systolic pressure between short-daily and conventional hemodialysis p = 0.39. However, similar blood pressures were achieved on fewer anti-hypertensive medications with short daily hemodialysis compared to conventional hemodialysis p = 0.01. Short daily hemodialysis, compared to conventional hemodialysis, was not associated with a difference in dry weight or ECFV p = 0.77. Sympathetic nervous system activity as assessed by plasma epinephrine p = 1.0 and norepinephrine p = 0.52 was also not different. Markers of inflammation p = 0.42 and oxidative stress p = 0.83 were also similar between the two treatment arms.


Patients treated with short daily, compared to conventional hemodialysis, have similar blood pressure control on fewer anti-hypertensive medications. The mechanisms by which short daily hemodialysis allows for decreased anti-hypertensive medication use remains unclear but effects on sodium balance and changes in peripheral vascular resistance require further study.

Trial Registration NCT00759967

Author: Deborah L. Zimmerman , Marcel Ruzicka, Paul Hebert, Dean Fergusson, Rhian M. Touyz, Kevin D. Burns



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