Fluid overload is associated with use of a higher number of antihypertensive drugs in hemodialysis patients

• Published in: Hemodialysis international Vol. 24; no. 3; pp. 397 - 405
• Main Authors: Morais, Jyana G., Pecoits‐Filho, Roberto, Canziani, Maria E. F., Poli‐de‐Figueiredo, Carlos E., Cuvello Neto, Américo L., Barra, Ana B., Calice‐Silva, Viviane, Raimann, Jochen G., Nerbass, Fabiana B.
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.07.2020
• Subjects: antihypertensive; Antihypertensive Agents - adverse effects; blood pressure; chronic kidney disease; Cross-Sectional Studies; Female; fluid overload; hemodialysis; Humans; Kidney Failure, Chronic - complications; Male; Middle Aged; Renal Dialysis - adverse effects; Water-Electrolyte Imbalance - chemically induced; hemodialysis; blood pressure; chronic kidney disease; antihypertensive; fluid overload
• ISSN: 1492-7535; 1542-4758; 1542-4758
• DOI: 10.1111/hdi.12829

ABSTRACT Introduction Hypertension is multifactorial, highly prevalent in the hemodialysis (HD) population and its adequate control requires, in addition to adequate volume management, often the use of multiple antihypertensive drugs. We aimed to describe the use of antihypertensive agents in a group of HD patients and to evaluate the factors associated with the use of multiple classes (≥3) of antihypertensives. Methods We analyzed the baseline data from the HDFit study. Clinically stable patients with HD vintage between 3 and 24 months without any severe mobility limitation were recruited from sites throughout southern Brazil. Fluid status was measured pre‐dialysis with the Body Composition Monitor (BCM; Fresenius, Germany). Fluid overload (FO) was considered when the overhydration index (OH) was greater than 7% of extracellular water (OH/ECW > 7%) and overweight was defined as a body mass index (BMI) greater than 25 kg/m2. Prescriptions of antihypertensive drugs were obtained from participants' reports and medical records. Logistic regression was employed to determine factors associated with excessive use of antihypertensive medication (≥3 classes). Findings Of 195 studied patients, 171 with complete data were included (70% male, 53 ± 15 years old, 57% of them with FO). Pre‐dialysis systolic blood pressure (SBP) was 150 ± 24 mmHg and patients used a median of 2 (1–3) antihypertensive drugs. Vasodilators (20%) were of lowest prevalence, use of other classes varied from 40% to 53%. Sixty‐two (36%) subjects used ≥3 classes and presented a higher prevalence of diabetes and FO, lower prevalence of overweight, and higher SBP. In a logistic regression model age, BMI <25 kg/m2, and OH/ECW > 7% were associated with excessive drug use. Discussion More than one‐third of participants used ≥3 classes of antihypertensive drugs, and it was associated with older age, BMI <25 kg/m2 and FO. Strategies that better manage FO may aid better blood pressure control and avoid the use of multiple antihypertensive medications.