ABSTRACT
BACKGROUND: Hypertension is one of the most critical risk factors for cardiovascular disease, which is the leading cause of death in hemodialysis (HD) patients. Medium cut-off (MCO) membrane increases the clearance of medium molecules, which could improve blood pressure (BP) control. This study aimed to compare the effect of MCO and high-flux hemodialysis membranes on BP assessed by ambulatory blood pressure monitoring (ABPM). METHODS: This is a pre-established secondary analysis of a 28-week, randomized, open-label crossover clinical trial. Patients were randomized to HD with MCO or high-flux membranes over 12 weeks, followed by a 4-week washout period, and then switched to the alternate membrane treatment for 12 weeks. ABPM was started before the HD session and ended at least 24 h later in weeks 1, 12, 16, and 28. RESULTS: 32 patients, 59% male, with a mean age of 52.7 years, and 40% with unknown CKD etiology, were enrolled. The dialysis vintage was 8 years, and more than 70% of the patients had hypertension. Regarding 24-h BP control, morning diastolic BP showed an increase in the high-flux compared to stability in the MCO group (interaction effect, p = 0.039). The adjusted ANOVA models showed no significant difference in the morning BP levels between the groups. Considering only the period of the HD session, patients in the MCO, compared to those in the high-flux membrane group, showed greater BP stability during dialysis, characterized by smaller variation in the pre-post HD systolic and minimum systolic BP (treatment effect, p = 0.039, and p = 0.023, respectively). CONCLUSIONS: MCO membrane seems to have a beneficial effect on morning BP and favors better BP stability during HD sessions.
Subject(s)
Blood Pressure Monitoring, Ambulatory , Cephalosporins , Hypertension , Humans , Male , Middle Aged , Female , Blood Pressure , Renal Dialysis/adverse effects , Hypertension/diagnosis , Hypertension/etiologyABSTRACT
Objetivo: Avaliar o controle da pressão arterial e fatores que nele interferem, em pacientes atendidos pelo programa Hiperdia em uma Unidade de Saúde da Família. Métodos: Foram entrevistados pacientes hipertensos cadastrados em duas equipes de Estratégia de Saúde da Família em Maceió, AL, que compareceram à reunião mensal do Hiperdia e aceitaram participar do estudo. A pressão arterial foi medida conforme as recomendações das VI Diretrizes Brasileiras de Hipertensão para validação do exame. Outras variáveis estudadas foram: sexo, idade, nível de escolaridade, ocupação, estado civil, tempo de tratamento, comorbidades, número de medicamentos, número de comprimidos diários e principal efeito colateral. Foram realizados os testes qui-quadrado e t-student para análise da influência das variáveis, estabelecendo nível de significância p < 0,05. Resultados: Entre os pacientes entrevistados, 91% mantinham pressão arterial em valores adequados. O controle da pressão arterial foi observado com maior frequência em pacientes casados, com maior nível de escolaridade, aposentados, com menor número de medicamentos e comprimidos diários, maior tempo de tratamento e sem efeitos colaterais. As variáveis: sexo, idade e comorbidades não apresentaram influência estatisticamente significante. Apenas 40% dos hipertensos cadastrados compareceram ao Hiperdia. Conclusão: O controle da pressão arterial nos pacientes que compareceram ao Hiperdia é muito mais frequente que em relatos de outros modelos de atenção à saúde. Os fatores com influência estatisticamente significante foram: nível de escolaridade, ocupação, estado civil, tempo de tratamento...
Objective: To evaluate the blood pressure control and factors that affect it, in patients seen by Hiperdia program at a Family Health Unit. Methods: Interviews were conducted with hypertensive patients enrolled in two teams of the Family Health Strategy in Maceio, AL, who attended the monthly meeting of Hiperdia and agreed to participate of study. Blood pressure was measured according to there commendations of the Brazilian Society of Cardiology for validation of the test. Other variables studied were sex, age, education level, occupation, marital status, duration of treatment, comorbidities, the number of medications, number of pills daily and main side effect. The chi-square and t-student tests were performed to analyze the influence of variables in the adherence, setting the significance level p < 0.05. Results: 91% of the interviewed patients maintained blood pressure at satisfactory values. The control of blood pressure levels were observed more frequently in patients married, more educated, retired, with fewer medicines and tablets daily, with longer treatment and without side effects. Variables that did not influence significantly the blood pressure control were: gender, age and comorbidities. Only 40% of patients enrolled in Hiperdia attended the mensal meeting. Conclusion: The blood pressure control in patients treated at Hiperdia program is much more frequent than reports of other models of health care. The factors that influenced significantly were: education level, occupation, marital status, duration of treatment, number of medications, number of tablets daily and main side effect. The number of registered patients who were absent from the meeting, however, was quite high...
