Background. Hypertension, which is often associated with hypervolaemia, is common in haemodialysis patients and is a known determinant of target organ damage. Interdialytic weight gain due to volume overload has also been associated with mortality in haemodialysis patients. Methods. We therefore studied 27 chronic haemodialysis patients who underwent 48-h ambulatory blood pressure monitoring between two midweek dialysis sessions, and 2D and M-mode echocardiography for determination of left ventricular mass index. Results. Left ventricular hypertrophy (left ventricular mass index in men > 131 g/m(2), women > 100 g/m(2)) was present in 70% (19/27) patients despite a mean 48-h blood pressure of 132 (plus or minus) 19/81 (plus or minus) 15 mmHg. Mean interdialytic weight gain was 1.6 (plus or minus) 0.8 kg and was not related to left ventricular mass index. Two patterns of interdialytic blood pressure change were apparent: in group 1 (16 patients) 48-h blood pressure increased (+ 19 (plus or minus) 12/13 (plus or minus) 9 mmHg), whereas in group 2 (11 patients) blood pressure fell (- 10 (plus or minus) 13/-8 (plus or minus) 10 mmHg P < 0.0001). In both groups the number of hypertensive patients (group 1, 10/16; group 2, 6/11), the 48-h blood pressure (132 (plus or minus) 20/80 (plus or minus) 15 vs 132 (plus or minus) 18/82 (plus or minus) 15 mmHg) and interdialytic weight gain (+ 1.9 (plus or minus) 0.7 vs + 1.3 (plus or minus) 0.7 kg) were similar. There was also no correlation between interdialytic blood pressure change and weight gain in either group. Conclusions. We conclude that interdialytic blood pressure changes cannot be directly related to interdialytic fluid gain, even in apparent volume-dependent hypertension, emphasizing the importance of additional factors in the control of blood pressure in end-stage renal disease.
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