Control de la hipertensión arterial mediante el esquema de hemodiálisis en días alternos (HDDA o «EODD»: «Every Other Day Dialysis») versus dos esquemas convencionales de 4 y 5 horas por sesión tres veces a la semana con 72 horas de fin de semana sin sesiones / Control of hypertension with different hemodialisis schedules

El aumento de la frecuencia de las sesiones de hemodiálisis garantiza un mejor control del volumen extracelular y de la hipertensión arterial, hechos que pueden reducir la mortalidad relacionada con patología cardiovascular entre la población en hemodiálisis. Describimos la evolución de la hipertensión arterial, en función de las necesidad de administración de fármacos antihipertensivos, en una población prevalente de 38 pacientes que iniciaron el esquema de hemodiálisis en días alternos sin descanso de 72 h de fin de semana, y la comparamos con 140 pacientes asimismo prevalentes que eran tratados en dos esquemas convencionales, previamente utilizados, con descanso de fin de semana y tres sesiones semanales de 4 y de 5 horas respectivamente; todos los pacientes habían permanecido durante más de 6 meses en hemodiálisis. El 68,4% (26/38) de los pacientes del esquema alterno presentaba hipertensión arterial al inicio del esquema alterno y tras 16,1 meses de permanencia media en el esquema solo mantuvieron medicación el 7,9% de ellos (3/38) con reducción en dos de los tres pacientes restantes (p < 0,001). Los 25 pacientes que cesaron o redujeron la medicación antihipertensiva lo hicieron en una media de 100 ± 15 días. La frecuencia final de hipertensión en diálisis alterna fue inferior a la que presentaban los 84 pacientes prevalentes con esquema de 4 horas x 3 sesiones x semana (60,7%) (p < 0,002) y a la de los 56 pacientes prevalentes con esquema de 5 horas x 3 sesiones x semana (25%: p = 0,065). Las diferencias entre las ganancias medias de peso entre sesiones con y sin fin de semana, los descensos medios del peso seco, las medias de tensión arterial y la frecuencia de hipotensiones, entre los pacientes en el esquema alterno y los del esquema con fin de semana y 3 sesiones de 4 horas durante la misma, alcanzaron diferencia significativa (p < 0,05). Estos mismos datos comparados con el mismo esquema pero con sesiones de 5 horas fueron mejores pero sin alcanzar significación estadística. El gasto farmacéutico en medicación antihipertensiva se redujo en un 87%. Nuestros resultados, empleando el esquema de hemodiálisis en días alternos sin descanso de 72 horas, apoyan experiencias previas (Lecce, Columbia) que consiguen controlar el peso seco tras hacer desaparecer el exceso de volumen acumulado en el fin de semana posibilitando unas tasas adecuadas de ultrafiltración, minimizando la aparición de hipertensión y de los síntomas de intolerancia en hemodiálisis, tan frecuentes en el esquema convencional

An increase in the frequency of hemodialysis sessions improves control of extracellular volume and blood hypertension and consequently reduces the mortality related to cardiovascular aetiology in hemodialysis patients. We report the evolution of the blood hypertension depending on the need for antihypertensive drugs in a group of 38 prevalent patients that were included in a every-otherday dialysis schedule (EODD), and compare it with the results in two other groups of prevalent patients that were dialyzed in conventional, previously employed schedules without week-end sessions 4hoursx3xweek and 5hoursx3xweek. All three groups received hemodialysis treatment for more than 6 months. A 68% (26/38) of the patients received antihypertensive treatment at the beginning the EODD schedule and, after 16 months, only 7.9% (3/38) of them required antihypertensive treatment (p < 0.001) with reduction in two of the three remanent patients; hypertension control in those 25 patients took an average of 100 ± 15 days. The final frequency of hypertension in EODD was lower (p < 0.002) than the frequency registered in the 84 prevalent patients in 4hx3xweek schedule, and also lower (p = 0.065) than the frequency of the 56 prevalent patients in 5hx3xweek schedule. There is a significant difference (p < 0,05) between EODD and 4hx3xweek schedule as regards average figures of: increase in weight, decrease in dry-weight, blood pressure levels and hypotension incidence. EODD also produced better results than 5hx3xweek schedule in this regard although statistics did not reflect it. The results using the every-other-day hemodialysis schedule support previous experiences (Lecce, Columbia) which achieved a good control of the dry-weight by means of suppressing the volume overload gained during the weekend and consequently obtaining adequate ultrafiltration rates and high reduction both of the hypertension and of the symptoms of intolerance to hemodialysis, which are so frequent in conventional schedules with 72 hours without hemodialysis sessions

[Control of arterial hypertension by means of a regimen of hemodialysis on alternate days (HDAA or EODD: "Every Other Day Dialysis") versus 2 conventional regiments of 4 and 5 hours per session 3 times a week with 72 hours without sessions during the weekends]. / Control de la hipertensión arterial mediante el esquema de hemodiálisis en días alternos (HDDA o EODD: "Every Other Day Dialysis") versus dos esquemas convencionales de 4 y 5 horas por sesión tres veces a la semana con 72 horas de fin de semana sin sesiones.

An increase in the frequency of hemodialysis sessions improves control of extracellular volume and blood hypertension and consequently reduces the mortality related to cardiovascular aetiology in hemodialysis patients.We report the evolution of the blood hypertension depending on the need for antihypertensive drugs in a group of 38 prevalent patients that were included in a every-other-day dialysis schedule (EODD), and compare it with the results in two other groups of prevalent patients that were dialyzed in conventional, previously employed schedules without week-end sessions 4 hours x 3 x week and 5 hours x 3 x week. All three groups received hemodialysis treatment for more than 6 months.A 68% (26/38) of the patients received antihypertensive treatment at the beginning the EODD schedule and, after 16 months, only 7.9% (3/38) of them required antihypertensive treatment (p < 0.001) with reduction in two of the three remanent patients; hypertension control in those 25 patients took an average of 100 +/- 15 days. The final frequency of hypertension in EODD was lower (p < 0.002) than the frequency registered in the 84 prevalent patients in 4h x 3 x week schedule, and also lower (p = 0.065) than the frequency of the 56 prevalent patients in 5h x 3 x week schedule. There is a significant difference (p < 0,05) between EODD and 4h x 3 x week schedule as regards average figures of: increase in weight, decrease in dry-weight, blood pressure levels and hypotension incidence. EODD also produced better results than 5h x 3 x week schedule in this regard although statistics did not reflect it. The results using the every-other-day hemodialysis schedule support previous experiences(Lecce, Columbia) which achieved a good control of the dry-weight by means of suppressing the volume overload gained during the weekend and consequently obtaining adequate ultrafiltration rates and high reduction both of the hypertension and of the symptoms of intolerance to hemodialysis, which are so frequent in conventional schedules with 72 hours without hemodialysis sessions.