Epidemiología de la hipertensión en hemodiálisis crónica / Prevalence of hypertension among patients on chronic hemodialysis

Background: Hypertension is a common and important cardiovascular risk factor in patients on chronic hemodialysis. Aim: To report the prevalence and characteristics of hypertension among patients on chronic hemodialysis. Patients and methods: Cross sectional study of 313 patients (192 male, aged 57 ñ 18 years) dialyzed in 7 representative centers in Santiago, Chile. Results: Patients were on hemodialysis for a mean of 68 ñ 53 months and 67 (21 percent) were diabetic. 230 (74 percent) were hypertensive and 223 of these (97 percent) had predialysis hypertension. A multivariate analysis showed that hypertension was associated with increased weight gain between dialysis, failure to achieve the postdialysis dry weight, increasing age and the presence of diabetes. Among hypertensive patients, 61 percent were receiving antihypertensive medications, compared with 27 percent of patients with normal blood pressure. Conclusions: High blood pressure is highly prevalent among patients on chronic hemodialysis and is associated to hypervolemia, age and the presence of diabetes

Anticoagulación en hemodiálisis con dósis única de heparina de bajo peso molecular / Anticoagulation during hemodialysis with a single dose of low molecular weight heparin

The aim of this work was to compare the benefits and problems of low molecular weight heparin use in chronic hemodialysis, compared to conventional heparin. We studied 35 patients that received low molecular weight heparine (Enoxaparine, molecular weight 4000) during 115 consecutive hemodialysis procedures and conventional heparin during the subsequent 35 procedures. We assessed the heparin dose, partial thromboplastin time before dialysis and at 3 and 120 min during the procedure, arterio-venous fistula compression time, clot formation in the circuit and residual volume of filters. Median total dose of conventional heparin was 6289 U (range 3000-10000) compared to 5555 U (range 2000-8000) of low molecular weight heparin. When the dose was calculated per kg of body weight, it was lower for low molecular weight heparin than for conventional heparin (87.8 U (range 33-100) vs 100 U (range 50-176). Partial thromboplastin time achieved was lower with low molecular weight heparin, compared with conventional heparin, at 3 (64.26 vs 125.2 sec) and 120 min (39.1 vs 84.45 sec). Clot formation, arteriovenous fistula compression time and residual volume of filters were similar for both types of heparin. It is concluded that a single dose of low molecular weight heparin simplifies anticoagulation during hemodialysis, modifies less the partial thromboplastin time and does not alter filter re-utilization