Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs. A prospective multicenter observational study.
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Abstract Background High blood pressure is a prevalent condition in patients with chronic kidney disease on hemodialysis. Adequate control of high blood pressure is essential to reduce deaths in this group of patients. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point of care dry weight (POCW) technique. Methods The present observational, prospective study was carried out at the Pafram Hemodiafiltration Unit in Morona Santiago, Ecuador, and the Hemodialysis Unit of the Fundación Renal del Ecuador in Guayaquil, Ecuador, from August 2019 to December 2023. Patients who were receiving hemodiafiltration were included. Weight was optimized with POCW. Group 1 included patients whose antihypertensive agents were not required to control blood pressure with a value less than 150/85 mmHg predialysis at eight weeks of POCW. In group 2, the patients required antihypertensive therapy. Clinical data, demographic data, mortality data, treatment descriptions, and routine laboratory test results during dialysis were included. The sample was nonprobabilistic. Survival analysis was carried out for the study groups. The log-rank test (Mantel-Cox) was used for survival comparisons. Results The study included 106 patients. Optimal blood pressure control without antihypertensive treatment was achieved in 52 patients (49.1%) (Group 1). In 54 patients (50.9%), antihypertensive agents were required (Group 2). There was more significant mortality in the group that received antihypertensives: 11 patients in group 1 (21.2%) versus 25 patients in group 2 (46.3%) (P = 0.005). Survival was more significant in group 1, with an HR of 2.2163 (1.125–4.158) (P = 0.0243). Conclusion Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs.
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Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs. A prospective multicenter observational study. | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs. A prospective multicenter observational study. Franklin Geovany Mora-Bravo, Pamela Tatiana Morales, Nelson Rojas, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4054177/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 17 Jan, 2025 Read the published version in BMC Nephrology → Version 1 posted 11 You are reading this latest preprint version Abstract Background High blood pressure is a prevalent condition in patients with chronic kidney disease on hemodialysis. Adequate control of high blood pressure is essential to reduce deaths in this group of patients. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point of care dry weight (POCW) technique. Methods The present observational, prospective study was carried out at the Pafram Hemodiafiltration Unit in Morona Santiago, Ecuador, and the Hemodialysis Unit of the Fundación Renal del Ecuador in Guayaquil, Ecuador, from August 2019 to December 2023. Patients who were receiving hemodiafiltration were included. Weight was optimized with POCW. Group 1 included patients whose antihypertensive agents were not required to control blood pressure with a value less than 150/85 mmHg predialysis at eight weeks of POCW. In group 2, the patients required antihypertensive therapy. Clinical data, demographic data, mortality data, treatment descriptions, and routine laboratory test results during dialysis were included. The sample was nonprobabilistic. Survival analysis was carried out for the study groups. The log-rank test (Mantel-Cox) was used for survival comparisons. Results The study included 106 patients. Optimal blood pressure control without antihypertensive treatment was achieved in 52 patients (49.1%) (Group 1). In 54 patients (50.9%), antihypertensive agents were required (Group 2). There was more significant mortality in the group that received antihypertensives: 11 patients in group 1 (21.2%) versus 25 patients in group 2 (46.3%) (P = 0.005). Survival was more significant in group 1, with an HR of 2.2163 (1.125–4.158) (P = 0.0243). Conclusion Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs. Antihypertensives Hemodiafiltration Mortality Point of Care Dry Weight Survival Figures Figure 1 Figure 2 Figure 3 Figure 4 Main messages • A lack of blood pressure control is a significant risk factor for mortality in patients with CKD undergoing hemodialysis or hemodiafiltration. • Patients with CKD who require the use of antihypertensive agents have a greater risk of mortality than patients with CKD who do not need the use of antihypertensive agents. • It is essential to identify and treat factors that contribute to a lack of blood pressure control in CKD patients via the Point of Care Dry Weight (POCW). Introduction High blood pressure is a prevalent condition in patients with chronic kidney failure (CKD). It is estimated that it affects between 60 and 90% of patients on hemodialysis and is associated with hypervolemia [ 1 ]. Hypertension is associated with hypervolemia due to excess sodium intake and poor dry weight adjustment. Other factors, such as vasodilation and sympathetic control, occur in 5 to 10% of patients on hemodialysis, accounting for 95 to 90% of the hypervolemia cases. Hypervolemia is an independent risk factor for fatal outcomes in patients with CKD on hemodialysis programs. Volume overload in hemodialysis patients is associated with hypertension and cardiac dysfunction and is a significant risk factor for cardiovascular and all-cause mortality in this population. Hypervolemia is also associated with an inflammatory state in hemodialysis patients [ 2 ]. Optimal volume management involves three key components: accurate estimation of volume status, correction of extracellular fluid overload, and prevention of intradialytic instability. A gold standard for assessing volume status is needed for an accurate estimate. Clinical examination has insufficient sensitivity and specificity; for example, the Tassin method of probing and dry weight was no longer associated with improved survival. Consequently, fluids are suggested to be managed even more actively, incorporating several objective measurements of volume status together [ 3 ]. Tools to assist in objectively measuring extracellular fluid volume require further validation. However, bioimpedance spectroscopy is arguably the most widely used method for subjectively quantifying fluid distributions in body compartments and produces reliable and reproducible results. Lung ultrasound provides reliable estimates of extravascular water in the lung, a critical parameter of the central circulation that primarily reflects left ventricular end-diastolic pressure [ 4 ]. However, these measurements still need to be applied in clinical practice. Recommendations for volume control include avoiding rapid correction of hypervolemia due to the risk of precipitating intradialysis hypotension and hypoperfusion of vital organs, including the heart, brain, liver, intestine, and kidneys [ 5 ]. To maximize cardiovascular tolerance, fluid elimination in volume-expanded HD patients should be gradual and distributed over a sufficiently long period [ 4 ]. Observational studies consistently show worse survival in patients with predialysis systolic blood pressure < 140/90 mmHg. However, such studies are likely confounded by low blood pressure due to CVD and other comorbidities [ 6 ]. Several treatment alternatives to reduce blood pressure in these patients do not require additional drug therapy (e.g., long slow hemodialysis, short daily hemodialysis, nocturnal hemodialysis, or dietary salt and fluid restriction, as well as reducing the sodium concentration in the dialysate). These parameters provide good blood pressure monitoring, even for patients with previously diagnosed hypertension [ 7 ]. Until additional data are available, we should treat hypertension during hemodialysis by actively pursuing euvolemia through dry weight catheterization and reducing excess salt [ 7 ]. On the other hand, the prescription of antihypertensives in normotensive patients is a problem, and a response needs to be identified. For example, a study demonstrated that a high plasma refilling rate at the beginning of hemodialysis is associated with intradialytic hypotension. This finding suggested that hypervolemia (high refilling) is a possible factor associated with intradialytic hypotension independent of the ultrafiltration refilling rate [ 8 ]; however, the effects of antihypertensive drugs have not been considered. The study hypothesizes that there is more remarkable survival in patients with CKD whose hypertension can be controlled without antihypertensives and with constant dry weight reduction measures to optimize ultrafiltration. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point of care dry weight (POCW) technique. Materials and Methods Study design The present study was observational. The source is prospective. Scenery The study was conducted in the Pafram Hemodiafiltration Unit in Sucúa, Morona Santiago-Ecuador, and the Fundación Renal del Ecuador Hemodialysis Unit in Guayaquil, Ecuador. The observation period ranged from August 1, 2019, to December 31, 2023. Participants Adult patients with a diagnosis of stage 5-d chronic renal failure in renal function replacement programs with hemodialysis or hemodiafiltration were included. Only patients who survived to baseline and had no missing covariates were included. The baseline survival time for this study was two months. Study groups Group 1 included patients whose dry weight was optimized and whose antihypertensive agent use was not required to control blood pressure to a value less than 150/85 mmHg before dialysis. Group 2 included patients who, after the dry weight optimization period (8 weeks), required antihypertensive therapy to control blood pressure to a value greater than 150/85 mmHg before dialysis. Variables The variables were age, sex, survival time in months, mortality, type and number of antihypertensive drugs used, comorbidities, smoking status, cause of chronic kidney disease, type of access, presence of diabetic blindness or significant vascular retinal lesion, presence of vascular amputation of limbs, presence of active cancer, treatment modality (hemodialysis-hemodiafiltration), and vintage. The average survival in the last month before data censoring was calculated for treatment variables such as pre and post-treatment weight, ultrafiltration, intradialytic weight gain, replacement volume, and effective blood flow (QB). The previous quartile of treatment survival averages for laboratory tests before data censoring were calculated. The laboratory parameters used were hemoglobin, lymphocytes, saturation of transferrin, ferritin, glucose, urea, creatinine, cholesterol, triglycerides, albumin, TGP, alkaline phosphatase, sodium, potassium, calcium, phosphate, and PTH. Data sources/measurements The source was direct; an electronic form was used to fill out the data collected during the study period. The information was confidential; no personal data were included in identifying the study subjects. The patients signed informed consent to participate in the study. Procedures Point-of-Care Dry Weight (POCW) The initial treatment weight was established for all patients, and a decision algorithm for ultrafiltration was established (Fig. 1 ). With this algorithm, continuous correction of dry weight was achieved for eight weeks. A nephrologist remained inside the hemodiafiltration room for 4 hours during each treatment. At the established time of 8 weeks, after the dry weight optimization period, antihypertensive treatment was started if the patient had a predialysis blood pressure greater than 150/85 mmHg. The blood pressure records present the average data on patient survival or censoring for the last month of treatment. Biases To avoid interviewer, information, and memory biases, the leading researcher always maintained the data with a guide and records approved in the research protocol. Observation and selection bias were avoided by applying participant selection criteria. Two researchers independently analyzed each record in duplicate, and the variables were registered in the database once their agreement was verified. Study size The sample was nonprobabilistic and census-type, where all possible cases from the study period were included. Quantitative variables Descriptive statistics were used. The results are expressed as frequencies (categorical variables) and means (numerical variables). Categorical data are presented in proportions. Statistical analysis Survival analysis was performed for the study groups. The log-rank test (Mantel–Co) was used for survival comparisons. The screening events included renal transplantation, modality change, and change in treatment location due to a change in address or study end. The statistical package used was SPSS 27.0 (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.). Results Participants The study included 106 patients. 52 patients (49.1%) achieved optimal blood pressure control without antihypertensive treatment (Group 1), and 54 patients (50.9%) required antihypertensive agents (Group 2). The 95% confidence interval for the proportion of patients in Group 1 was 39.58%- 58.62%. Figure 2 shows the distribution of the frequency of arterial hypertension according to the average blood pressure obtained in the last month of follow-up or censoring. Characteristics of the study groups. There were 34 women (65.4%) in group 1 and 19 women (35.2%) in group 2 (P = 0.002). A total of 80.2% of all patients underwent hemodiafiltration treatments. The average age was 50.7 years in Group 1 and 59.2 years in Group 2 (P = 0.018). The two groups had similar body mass indices. The antihypertensive group had greater height and body weight. In group 2, there were 37 patients (68.5%) treated with amlodipine, 24 (44.4%) with atenolol/carvedilol, 19 (35.2%) with losartan and 7 (13%) with other antihypertensives. In group 2, 25 patients (48.2%) used one antihypertensive drug, 20 patients (37%) used two antihypertensive medications, and eight patients (14.8%) used three antihypertensive drugs. Table 1 presents the data related to hemodialysis or hemodiafiltration treatment. Table 1 Variables of the study group Group 1 Without Antihipertensives N = 52 Group 2 With Antihypertensives n = 54 P Age (Years) 50.7 ± 21.1 59.2 ± 14.4 0.018 Heigt (Cm) 153.2 ± 8.7 157.4 ± 10.0 0.025 BMI (kg/m2) 24.92 ± 4.1 26.18 ± 4.9 0.160 Treatment data (average of the last month) Pretreatment weight (kg) 60.44 ± 14.02 66.75 ± 15.83 0.032 Ultrafiltration (L) 3.022 ± 0.900 2.753 ± 0.873 0.122 Posttreatment weigth (kg) 57.60 ± 13.70 64.09 ± 15.75 0.026 IDWG (%) 5.44 ± 1.76 4.45 ± 1.57 0.003 Systolic blood pressure pretratment (mmHg) 137.8 ± 23.8 143.7 ± 24.5 0.209 HDF volumen (L) 21.92 ± 3.29 22.90 ± 6.29 0.360 HDF time (min) 216.9 ± 10.5 214.9 ± 15.2 0.415 Efecctive blood rate -QB (Ml/min) 438.5 ± 48.5 412.4 ± 53.0 0.005 Laboratory tests (average of the last 3 months) Hemoglobine g/dl 10.66 ± 1.82 10.64 ± 2.05 0.950 Linfocites (u/ul) 1.844 ± 0.523 1.865 ± 0.523 0.859 Saturation of transferrine (%) 25.31 ± 13.49 32.75 ± 17.23 0.009 Ferritine (mg/dl) 258.9 ± 415.1 388.5 ± 472.3 0.151 Glucose (Mg/dl) 131.9 ± 75.1 174.2 ± 107.1 0.021 Urea (mg/dl) 95.5 ± 35.9 120.3 ± 53.1 0.006 Creatinine (mg/dl) 8.00 ± 2.70 8.22 ± 4.25 0.753 Cholesterol (Mg/dl) 189.6 ± 44.5 178.3 ± 41.7 0.238 Triglicerides (mg/dl) 157.1 ± 94.1 174.7 ± 95.0 0.397 Albumine (G/dl) 4.24 ± 0.49 3.98 ± 0.56 0.007 TGP (U/L) 24.6 ± 56.6 19.4 ± 13.0 0.518 Phosphatase alcaline (U/L) 174.8 ± 116.3 177.4 ± 114.1 0.915 Sodium (meq/l) 134.09 ± 3.89 134.60 ± 4.74 0.551 Potasium (meq/l) 5.17 ± 0.84 5.12 ± 0.83 0.765 Calcium (mg/dl) 9.10 ± 0.96 9.03 ± 1.44 0.777 Phosphate (mg/dl) 4.92 ± 1.64 5.11 ± 1.76 0.577 Paratohormone (pg/dl) 363.6 ± 230.8 342.1 ± 289.4 0.692 HDF: Hemodiafiltration. IDWG: interdialytic weight gain. HDF Factors associated with the use of antihypertensive agents The 50th percentile (P50) was used to categorize the variables on a scale. The P50 values for the scale variables were as follows: IDWG, 4.925%; effective QB, 423.5 ml/min; transferrin saturation, 26.75%; glucose, 109.27 mg/dl; urea, 103.775 mg/dl; and albumin, 4.214 g/dl. The risk factors for the use of antihypertensive agents were the presence of vascular amputation, a history of smoking, the presence of a diagnosis of type 2 diabetes mellitus, a % transferrin saturation > 26.75%, male sex, and hemodialysis as the treatment type. A diagnosis of glomerulonephritis as the etiology of chronic renal failure, a history of never smoking, a serum ALB concentration > 4.216 g/dl, an effective Qb greater than 423.5 ml/min, an IDWG greater than 4.925%, hemodiafiltration as treatment, urea < 103.78 mg/dl, and fasting glucose < 109.27 mg/dl were identified as statistically significant protective factors (Table 2 ). Table 2 Risk and protective factors for the use of antihypertensives. Group 1 Without Antihipertensives N = 52 Group 2 With Antihypertenives n = 54 P OR* 95% CI of the OR Risk factor's Legs vascular amputation 0 (0%) 9 (16.7%) 0.002 21.923 1.241-387.216 Ex-smoker 1 (1.9%) 10 (18.5%) 0.005 11.591 1.427–94.163 Type 2 Diabetes 19 (36.5%) 35 (64.8%) 0.003 3.199 1.446–7.078 Transferrine saturation > 26.75% 21 (40%) 35 (64.8%) 0.010 2.719 1.238–5.972 Male 18 (34.6%) 35 (64.8%) 0.002 1.842 1.224–2.772 Female 34 (65.4%) 19 (35.2%) Hemodialysis as treatment 5 (9.6%) 16 (29.6%) 0.009 1.704 1.218–2.385 Protection factors Glomerulonephritis as ethiology of CKD 16 (30.7%) 5 (9.3%) 0.005 0.230 0.077–0.685 Smokin never 44 (84.6%) 31 (57.4%) 0.002 0.245 0.097–0.619 Albumine > 4.214 gr/dL 31 (59.6%) 19 (35.2%) 0.010 0.368 0.167–0.808 Efective QB > 423.5 ml/min 32 (61.5%) 21 (38.9%) 0.016 0.398 0.182–0.869 IDWG > 4.925% 32 (61.5%) 22 (40.7%) 0.026 0.430 0.197–0.936 Hemodiafiltration as treatment 47 (90.4%) 38 (70.4%) 0.009 0.431 0.196–0.947 Urea < 103.78 mg/dL 31 (59.6%) 21 (38.9%) 0.026 0.661 0.446–0.979 Glucose < 109.27 mg/dl 31 (59.6%) 19 (35.2%) 0.012 0.608 0.404–0.914 Nonsignificant factors Current-smoker 1 (1.9%) 0 (0%) 0.491 0.339 0.014–8.529 Hypertension as ethiology of CKD 8 (15.4%) 6 (11.1%) 0.359 0.688 0.221–2.138 Polycistic Kidney disease 3 (5.8%) 2 (3.7%) 0.482 0.628 0.101–3.921 CKD of unkonown ethiology 8 (15.4%) 7 (13.0%) 0.468 0.819 0.274–2.447 Access fistula 40 (76.9%) 39 (72.2%) 0.370 0.780 0.324–1.877 Access Graft 4 (7.7%) 1 (1.91%) 0.170 0.226 0.024–2.097 Catheter 8 (15.4%) 14 (25.9%) 0.136 1.925 0.731–5.070 Diabetic blindness or significant retinal vascular injury 6 (11.5%) 14 (25.9%) 0.049 2.683 0.943–7.638 Cancer 1 (1.9%) 1 (1.9%) 0.743 0.962 0.059–15.798 *Odds ratio for the presence of the risk factor and the use of antihypertensive drugs. Main results Mortality and survival analysis The group that required antihypertensive agents had a significantly greater rate of mortality, with 11 patients (21.2%) compared to 25 patients (46.3%) in the other group (P = 0.005). On the other hand, group 1 had higher survival rates, with an HR of 2.2163 (1.125–4.158) and P = 0.0243, as shown in Fig. 3 . The antihypertensive agent group (Group 2) had a survival time of 46 months, while Group 1 had indefinite survival, with a 70% probability of survival at 144 months at the end of the study. Secondary analyses The Cox equation was used to predict the outcome of antihypertensive medication use based on survival (Table 3 ). The variables were significant: age, transferrin saturation, serum albumin concentration, and history of vascular amputation of a limb or part of the limb. According to the analysis stratified by sextile, a sextile less than 141 mmHg and greater than 122 mmHg predialysis systolic blood pressure and the use of antihypertensive agents increased the risk of death [HR 4.877 (1.297–18.34) P = 0.0141]. With a predialysis systolic blood pressure of less than 105 mmH6, antihypertensive therapy increased the risk of death [HR 4.764 (1.138–19.94) P = 0.010]. No other significant associations were found according to blood pressure level (Fig. 4 ). Table 3 Variables in the COX Equation. B SE Wald df Sig. Exp(B) 95.0% CI for Exp(B) Lower Upper Age (Years) 0.035 .017 4.201 1 .040 1.036 1.002 1.072 Saturation of Transferrine (%) -0.028 .014 3.759 1 .053 .973 .946 1.000 Albumine (g/dl) -2.093 .398 27.692 1 < .001 .123 .057 .269 Vascular amputation of a leg or part of it 1.363 .582 5.494 1 .019 3.909 1.250 12.222 -2 Log Likelihood 156.9, Chi-square 42.5, df 4, Sig < 0.001 Discussion Main findings of the study The main finding confirms the hypothesis of the study that there is more remarkable survival in the group of patients with CKD whose hypertension can be controlled without antihypertensive treatment and with the use of constant dry weight reduction measures to optimize ultrafiltration. The factors associated with the lack of control of arterial hypertension were a history of vascular amputation, a history of being an ex-smoker, being a carrier of type 2 diabetes mellitus, having a serum ferritin level greater than 26.75%, being male, and being treated with hemodialysis. The associated protective factors were having a diagnosis of glomerulonephritis as an etiology of chronic kidney disease, a history of never smoking, a serum ALB concentration greater than 4.214 g/dl, effective blood flow greater than 423.5 ml/min, and interdialytic weight gain > 4.925%, hemodiafiltration as treatment, urea levels less than 103.78 mg/dl, and fasting glucose levels less than 109.2 mg/dl. According to the time-adjusted model, only four factors were associated: age, transferrin saturation, serum albumin levels, and history of vascular amputation. In the stratified analysis, differences in survival were demonstrated by the percentiles of blood pressure taken in the last month of survival or censoring. With blood pressures ranging from 141 mmHg to 122 mmHg, there is a proportional risk of death associated with the intake of antihypertensive agents. The same occurs when the blood pressure is less than 105 mmHg. These relationships could not be established with pressures greater than 141 mmHg. Importance of the findings These findings are significant because they suggest that a lack of blood pressure control in patients with CKD undergoing hemodiafiltration or hemodialysis, despite optimization of dry weight, may be associated with poorer survival. Adequate blood pressure control is essential for reducing the risk of cardiovascular events, such as myocardial infarction, stroke, and death. In this study, blood pressure control with ultrafiltration was possible in 49.1% of patients, with a confidence interval ranging from 39.58–58.62%. This finding suggested that identifying and treating factors contributing to the lack of blood pressure control is essential. Some factors that may contribute to the lack of blood pressure control in patients with CKD include hypervolemia, malnutrition, excess transferrin saturation, and arteriolopathy, which can cause peripheral ischemia (vascular amputation). Studies with related findings Similar observational studies have been presented previously [ 9 – 10 ]; however, these studies do not consider the differentiation of greater or lesser mortality between patients taking antihypertensive medications. Specifically, in patients undergoing hemodiafiltration, the CONVINCE study published in 2023 included patients who were receiving hemodiafiltration treatments and had lower mortality than were found in patients receiving hemodialysis (HR 0.77 95% CI 0.65–0.93); however, it did not distinguish groups in the subanalyses of patients receiving antihypertensive treatments [ 11 ]. One clinical study of 126 hemodialysis patients was randomized into two groups: the first had a systolic pressure of 110–140 mmHg and intensive antihypertensive treatment, and the second had a systolic pressure of 155–165 mmHg and standard treatment. The follow-up time was one year. There was no difference in mortality between the groups studied: 4 deaths in the intensive group versus 1 in the standard group (OR 4.34 95% CI 0.47-40) P = 0.1947 [ 12 ]. Alternative explanations The study deals specifically with hemodialysis patients whose blood pressure cannot be controlled with ultrafiltration measures alone, diet, or water restriction but requires additional measures such as antihypertensive drugs. Clearly, in this group of patients with uncontrollable hypertension, dietary transgressors who did not limit their sodium and liquid intake were included, patients with malnutrition and low oncotic pressure were included, and patients with arteriolopathy were included. With clinical assessment at the bedside, an attempt was made to exclude hypovolemic patients from the group who unnecessarily took antihypertensive medications. Clinical relevance of the findings This study provides a methodology for continuous ultrafiltration with point-of-care dry weight. This methodology can lead to using an artificial intelligence algorithm for automated dry-weight programming. Additionally, of clinical relevance is the fact that hemodiafiltration treatment, in addition to having a clinically effective replacement volume (> 22 liters), requires an extracorporeal flow prescription good enough to provide adequate clearance (Qb greater than 423.5 ml/min). Limitations of the study Small sample size. However, additional multicenter studies are needed to validate our results. A limitation was the need for a record of the doses of erythropoietin administered during the period that may be related to arterial hypertension. Another limitation is the lack of a bioimpedance assessment in the cases presented. Future investigations Future studies should address dry weight obtained by impedance and its long-term relationship with antihypertensive agents. Conclusions The findings of this study suggest that blood pressure control with active ultrafiltration measures and without the use of antihypertensive agents is an essential factor that contributes to more remarkable survival in patients with CKD in hemodiafiltration and hemodialysis programs. The use of antihypertensive drugs in patients on hemodiafiltration and hemodialysis programs, with pressures between 141 and 122 mmH and less than 105 mmHg, can be harmful. Abbreviations CKD Chronic kidney disease HR Hazard ratio POCW Point of Care Dry Weight Declarations Data availability statement The data supporting this study are included in the supporting materials. Acknowledgements We thank the Ecuadorian Society of Nephrology for facilitating connections between cooperating centers. In memory of Doctor Héctor Perez-Grovas (1951-2022). Funding: The authors of this article funded the costs of this research. Laboratory tests are part of the usual activity of hemodialysis units in Ecuador and do not represent costs for patients or researchers. Authors‘ contributions Franklin Geovany Mora-Bravo: Conceptualization, Methodology, validation, formal analysis, investigation, data curation, writing-original. Pamela Tatiana Morales Torres: Sofware, resources, supervision, project administration, funding acquisition. Nelson Rojas Campoverde: investigation, resources, data curation, writing-original. Guillermina Lucía Blum Carcelen: Resources, supervision, investigation, resources, data curation, writing-original. Juan Cristobal Santacruz Mancheno: Resources, investigation, resources, data curation, writing-original. Ángel Cristóbal Santacruz Tipanta: Conceptualization, Methodology, resources. Hector Perez-Grovas: Conceptualization, Methodology. Ethics committee approval and consent to participate The Ethics Committee of the Ecuatorian Society of Nephrology approved this study. Informed consent was obtained from all participating subjects. Conflict of interest statement: The authors declare that they have no conflicts of interest. References Symonides B, Lewandowski J, Małyszko J. Resistant hypertension in dialysis. Nephrol Dial Transplant. 2023;38(9):1952–1959. 10.1093/ndt/gfad047 . PMID: 36898677. Ulrich C, Canim Z, Herberger E, Girndt M, Fiedler R. Inflammation in Hypervolemic Hemodialysis Patients: The Roles of RelB and Caspase-4. Int J Mol Sci. 2023;24(24):17550. 10.3390/ijms242417550 . PMID: 38139378; PMCID: PMC10743509. Hecking M, Schmiedecker M, Waller M, Gil SL, Bieber B, Jean G, Chazot C. Active fluid management in Tassin/France of the 21st century and outcomes. Kidney Int. 2022;102(6):1427–1428. 10.1016/j.kint.2022.09.010 . PMID: 36411021. Loutradis C, Sarafidis PA, Ferro CJ, Zoccali C. Volume overload in hemodialysis: diagnosis, cardiovascular consequences, and management. Nephrol Dial Transpl. 2021;36(12):2182–93. 10.1093/ndt/gfaa182 . 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Association of blood pressure with mortality in hemodialysis patients with a tunneled cuffed catheter: A single-center observational study. Med (Baltim). 2020;99(37):e22002. 10.1097/MD.0000000000022002 . PMID: 32925731; PMCID: PMC7489610. Georgianos PI, Agarwal R. Blood Pressure and Mortality in Long-Term Hemodialysis-Time to Move Forward. Am J Hypertens. 2017;30(3):211–22. 10.1093/ajh/hpw114 . PMID: 27661097; PMCID: PMC5861571. Blankestijn PJ, Vernooij RWM, Hockham C, Strippoli GFM, Canaud B, Hegbrant J, Barth C, Covic A, Cromm K, Cucui A, Davenport A, Rose M, Török M, Woodward M, Bots ML, CONVINCE Scientific Committee Investigators. Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure. N Engl J Med. 2023;389(8):700–9. 10.1056/NEJMoa2304820 . Epub 2023 Jun 16. PMID: 37326323. Miskulin DC, Gassman J, Schrader R, Gul A, Jhamb M, Ploth DW, Negrea L, Kwong RY, Levey AS, Singh AK, Harford A, Paine S, Kendrick C, Rahman M, Zager P. BP in Dialysis: Results of a Pilot Study. J Am Soc Nephrol. 2018;29(1):307–16. Epub 2017 Dec 6. PMID: 29212839; PMCID: PMC5748902. Additional Declarations No competing interests reported. Supplementary Files BDPOCWstudy.sav Cite Share Download PDF Status: Published Journal Publication published 17 Jan, 2025 Read the published version in BMC Nephrology → Version 1 posted Editorial decision: Revision requested 09 Sep, 2024 Reviews received at journal 05 Sep, 2024 Reviewers agreed at journal 04 Sep, 2024 Reviews received at journal 28 May, 2024 Reviewers agreed at journal 15 May, 2024 Reviewers agreed at journal 15 May, 2024 Reviewers invited by journal 15 May, 2024 Editor assigned by journal 15 May, 2024 Editor invited by journal 24 Feb, 2024 Submission checks completed at journal 24 Feb, 2024 First submitted to journal 16 Feb, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4054177","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":326774035,"identity":"fc866c01-1daa-4330-94b9-10d9d4655e47","order_by":0,"name":"Franklin Geovany Mora-Bravo","email":"data:image/png;base64,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","orcid":"","institution":"Pafram, Hemodiafiltration Unit, Complementary Health Network","correspondingAuthor":true,"prefix":"","firstName":"Franklin","middleName":"Geovany","lastName":"Mora-Bravo","suffix":""},{"id":326774036,"identity":"71626932-4ad4-49bb-b232-cd2c5ff53b11","order_by":1,"name":"Pamela Tatiana Morales","email":"","orcid":"","institution":"Pafram, Hemodiafiltration Unit, Complementary Health Network","correspondingAuthor":false,"prefix":"","firstName":"Pamela","middleName":"Tatiana","lastName":"Morales","suffix":""},{"id":326774037,"identity":"d8a9df64-43c5-47f9-bba6-33b3873a6c3a","order_by":2,"name":"Nelson Rojas","email":"","orcid":"","institution":"Hemodialysis Unit of the Renal Foundation of Ecuador","correspondingAuthor":false,"prefix":"","firstName":"Nelson","middleName":"","lastName":"Rojas","suffix":""},{"id":326774038,"identity":"81ba8621-75cf-4307-bc7a-095ef9e0dd0a","order_by":3,"name":"Guillermina Lucía Blum","email":"","orcid":"","institution":"Hemodialysis Unit of the Renal Foundation of Ecuador","correspondingAuthor":false,"prefix":"","firstName":"Guillermina","middleName":"Lucía","lastName":"Blum","suffix":""},{"id":326774039,"identity":"b8e8c120-74a3-4c23-9ae6-6d1dc8acc187","order_by":4,"name":"Juan Cristobal Santacruz","email":"","orcid":"","institution":"Menydial Kidney Clinic: Quito","correspondingAuthor":false,"prefix":"","firstName":"Juan","middleName":"Cristobal","lastName":"Santacruz","suffix":""},{"id":326774041,"identity":"7478f72d-c042-4d8b-96fd-4811e782d8f3","order_by":5,"name":"Angel Cristobal Santacruz","email":"","orcid":"","institution":"Menydial Kidney Clinic: Quito","correspondingAuthor":false,"prefix":"","firstName":"Angel","middleName":"Cristobal","lastName":"Santacruz","suffix":""},{"id":326774042,"identity":"8ab07e06-ef0c-4a03-b1ea-00312b35475d","order_by":6,"name":"Hector Perez-Grovas","email":"","orcid":"","institution":"Instituto Nacional de Cardiología Ignacio Chavez","correspondingAuthor":false,"prefix":"","firstName":"Hector","middleName":"","lastName":"Perez-Grovas","suffix":""},{"id":326774044,"identity":"eb1a8fc5-a5e5-4a00-91ab-abf59e13b0eb","order_by":7,"name":"William Robles","email":"","orcid":"","institution":"Hospital del IESS de Ambato","correspondingAuthor":false,"prefix":"","firstName":"William","middleName":"","lastName":"Robles","suffix":""}],"badges":[],"createdAt":"2024-03-09 09:31:15","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4054177/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4054177/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12882-025-03948-0","type":"published","date":"2025-01-17T15:57:04+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":61197340,"identity":"3a88447f-cd20-4e80-b9e2-dab81aec4481","added_by":"auto","created_at":"2024-07-27 00:31:07","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":8888,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003ePoint-of-Care Dry Weight\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePoint of Care Dry Weight (POCW) algorithm.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4054177/v1/6519dbd3583bf07e09858d10.png"},{"id":61197341,"identity":"9d80fa74-a2a3-4109-9bef-b1032b2ca420","added_by":"auto","created_at":"2024-07-27 00:31:07","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":13358,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy participants classified by blood pressure sextiles.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4054177/v1/44c9f08792deb13c33aa7b92.png"},{"id":61197342,"identity":"fb3eda07-3adb-4ea6-ac3d-d26835fc6bff","added_by":"auto","created_at":"2024-07-27 00:31:07","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":34227,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eSurvival proportions.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4054177/v1/c5ebd985d136fe7054240be5.png"},{"id":61197345,"identity":"a1b24389-3ef7-4c05-857f-983f62c6f7fb","added_by":"auto","created_at":"2024-07-27 00:31:08","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":23075,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eHazard ratio according to sextile blood pressure.\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4054177/v1/433eb469258236e1c0e2fd09.png"},{"id":74284706,"identity":"32a753e6-3cb1-4229-aa9c-54a4ad745a54","added_by":"auto","created_at":"2025-01-20 16:11:17","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1298958,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4054177/v1/344a2c59-a945-45d1-b9f3-3aad3a02701e.pdf"},{"id":61197344,"identity":"c641e3a0-f56e-4012-a1e1-e7d5846b18f7","added_by":"auto","created_at":"2024-07-27 00:31:08","extension":"sav","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":35348,"visible":true,"origin":"","legend":"","description":"","filename":"BDPOCWstudy.sav","url":"https://assets-eu.researchsquare.com/files/rs-4054177/v1/63d86253d78dc79e9830a14c.sav"}],"financialInterests":"No competing interests reported.","formattedTitle":"Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs. A prospective multicenter observational study.","fulltext":[{"header":"Main messages","content":"\u003cp\u003e\u0026bull; A lack of blood pressure control is a significant risk factor for mortality in patients with CKD undergoing hemodialysis or hemodiafiltration.\u003c/p\u003e\n\u003cp\u003e\u0026bull; Patients with CKD who require the use of antihypertensive agents have a greater risk of mortality than patients with CKD who do not need the use of antihypertensive agents.\u003c/p\u003e\n\u003cp\u003e\u0026bull; It is essential to identify and treat factors that contribute to a lack of blood pressure control in CKD patients via the Point of Care Dry Weight (POCW).\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eHigh blood pressure is a prevalent condition in patients with chronic kidney failure (CKD). It is estimated that it affects between 60 and 90% of patients on hemodialysis and is associated with hypervolemia [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Hypertension is associated with hypervolemia due to excess sodium intake and poor dry weight adjustment. Other factors, such as vasodilation and sympathetic control, occur in 5 to 10% of patients on hemodialysis, accounting for 95 to 90% of the hypervolemia cases.\u003c/p\u003e \u003cp\u003eHypervolemia is an independent risk factor for fatal outcomes in patients with CKD on hemodialysis programs. Volume overload in hemodialysis patients is associated with hypertension and cardiac dysfunction and is a significant risk factor for cardiovascular and all-cause mortality in this population. Hypervolemia is also associated with an inflammatory state in hemodialysis patients [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOptimal volume management involves three key components: accurate estimation of volume status, correction of extracellular fluid overload, and prevention of intradialytic instability.\u003c/p\u003e \u003cp\u003eA gold standard for assessing volume status is needed for an accurate estimate. Clinical examination has insufficient sensitivity and specificity; for example, the Tassin method of probing and dry weight was no longer associated with improved survival. Consequently, fluids are suggested to be managed even more actively, incorporating several objective measurements of volume status together [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Tools to assist in objectively measuring extracellular fluid volume require further validation. However, bioimpedance spectroscopy is arguably the most widely used method for subjectively quantifying fluid distributions in body compartments and produces reliable and reproducible results. Lung ultrasound provides reliable estimates of extravascular water in the lung, a critical parameter of the central circulation that primarily reflects left ventricular end-diastolic pressure [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, these measurements still need to be applied in clinical practice.\u003c/p\u003e \u003cp\u003eRecommendations for volume control include avoiding rapid correction of hypervolemia due to the risk of precipitating intradialysis hypotension and hypoperfusion of vital organs, including the heart, brain, liver, intestine, and kidneys [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. To maximize cardiovascular tolerance, fluid elimination in volume-expanded HD patients should be gradual and distributed over a sufficiently long period [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eObservational studies consistently show worse survival in patients with predialysis systolic blood pressure\u0026thinsp;\u0026lt;\u0026thinsp;140/90 mmHg. However, such studies are likely confounded by low blood pressure due to CVD and other comorbidities [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Several treatment alternatives to reduce blood pressure in these patients do not require additional drug therapy (e.g., long slow hemodialysis, short daily hemodialysis, nocturnal hemodialysis, or dietary salt and fluid restriction, as well as reducing the sodium concentration in the dialysate). These parameters provide good blood pressure monitoring, even for patients with previously diagnosed hypertension [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Until additional data are available, we should treat hypertension during hemodialysis by actively pursuing euvolemia through dry weight catheterization and reducing excess salt [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eOn the other hand, the prescription of antihypertensives in normotensive patients is a problem, and a response needs to be identified. For example, a study demonstrated that a high plasma refilling rate at the beginning of hemodialysis is associated with intradialytic hypotension. This finding suggested that hypervolemia (high refilling) is a possible factor associated with intradialytic hypotension independent of the ultrafiltration refilling rate [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]; however, the effects of antihypertensive drugs have not been considered. The study hypothesizes that there is more remarkable survival in patients with CKD whose hypertension can be controlled without antihypertensives and with constant dry weight reduction measures to optimize ultrafiltration. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point of care dry weight (POCW) technique.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design\u003c/h2\u003e \u003cp\u003eThe present study was observational. The source is prospective.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eScenery\u003c/h2\u003e \u003cp\u003eThe study was conducted in the Pafram Hemodiafiltration Unit in Suc\u0026uacute;a, Morona Santiago-Ecuador, and the Fundaci\u0026oacute;n Renal del Ecuador Hemodialysis Unit in Guayaquil, Ecuador. The observation period ranged from August 1, 2019, to December 31, 2023.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eAdult patients with a diagnosis of stage 5-d chronic renal failure in renal function replacement programs with hemodialysis or hemodiafiltration were included. Only patients who survived to baseline and had no missing covariates were included. The baseline survival time for this study was two months.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eStudy groups\u003c/h2\u003e \u003cp\u003eGroup 1 included patients whose dry weight was optimized and whose antihypertensive agent use was not required to control blood pressure to a value less than 150/85 mmHg before dialysis.\u003c/p\u003e \u003cp\u003eGroup 2 included patients who, after the dry weight optimization period (8 weeks), required antihypertensive therapy to control blood pressure to a value greater than 150/85 mmHg before dialysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cp\u003eThe variables were age, sex, survival time in months, mortality, type and number of antihypertensive drugs used, comorbidities, smoking status, cause of chronic kidney disease, type of access, presence of diabetic blindness or significant vascular retinal lesion, presence of vascular amputation of limbs, presence of active cancer, treatment modality (hemodialysis-hemodiafiltration), and vintage. The average survival in the last month before data censoring was calculated for treatment variables such as pre and post-treatment weight, ultrafiltration, intradialytic weight gain, replacement volume, and effective blood flow (QB). The previous quartile of treatment survival averages for laboratory tests before data censoring were calculated. The laboratory parameters used were hemoglobin, lymphocytes, saturation of transferrin, ferritin, glucose, urea, creatinine, cholesterol, triglycerides, albumin, TGP, alkaline phosphatase, sodium, potassium, calcium, phosphate, and PTH.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eData sources/measurements\u003c/h2\u003e \u003cp\u003eThe source was direct; an electronic form was used to fill out the data collected during the study period. The information was confidential; no personal data were included in identifying the study subjects. The patients signed informed consent to participate in the study.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eProcedures\u003c/h2\u003e \u003cdiv id=\"Sec10\" class=\"Section3\"\u003e \u003ch2\u003ePoint-of-Care Dry Weight (POCW)\u003c/h2\u003e \u003cp\u003eThe initial treatment weight was established for all patients, and a decision algorithm for ultrafiltration was established (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). With this algorithm, continuous correction of dry weight was achieved for eight weeks. A nephrologist remained inside the hemodiafiltration room for 4 hours during each treatment. At the established time of 8 weeks, after the dry weight optimization period, antihypertensive treatment was started if the patient had a predialysis blood pressure greater than 150/85 mmHg. The blood pressure records present the average data on patient survival or censoring for the last month of treatment.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eBiases\u003c/h2\u003e \u003cp\u003eTo avoid interviewer, information, and memory biases, the leading researcher always maintained the data with a guide and records approved in the research protocol. Observation and selection bias were avoided by applying participant selection criteria. Two researchers independently analyzed each record in duplicate, and the variables were registered in the database once their agreement was verified.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eStudy size\u003c/h2\u003e \u003cp\u003eThe sample was nonprobabilistic and census-type, where all possible cases from the study period were included.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eQuantitative variables\u003c/h2\u003e \u003cp\u003eDescriptive statistics were used. The results are expressed as frequencies (categorical variables) and means (numerical variables). Categorical data are presented in proportions.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eSurvival analysis was performed for the study groups. The log-rank test (Mantel\u0026ndash;Co) was used for survival comparisons. The screening events included renal transplantation, modality change, and change in treatment location due to a change in address or study end. The statistical package used was SPSS 27.0 (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp.).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eParticipants\u003c/h2\u003e \u003cp\u003eThe study included 106 patients. 52 patients (49.1%) achieved optimal blood pressure control without antihypertensive treatment (Group 1), and 54 patients (50.9%) required antihypertensive agents (Group 2). The 95% confidence interval for the proportion of patients in Group 1 was 39.58%- 58.62%. Figure\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e2\u003c/span\u003e shows the distribution of the frequency of arterial hypertension according to the average blood pressure obtained in the last month of follow-up or censoring.\u003c/p\u003e \u003cp\u003e \u003cb\u003eCharacteristics of the study groups.\u003c/b\u003e \u003c/p\u003e \u003cp\u003eThere were 34 women (65.4%) in group 1 and 19 women (35.2%) in group 2 (P\u0026thinsp;=\u0026thinsp;0.002). A total of 80.2% of all patients underwent hemodiafiltration treatments. The average age was 50.7 years in Group 1 and 59.2 years in Group 2 (P\u0026thinsp;=\u0026thinsp;0.018). The two groups had similar body mass indices. The antihypertensive group had greater height and body weight. In group 2, there were 37 patients (68.5%) treated with amlodipine, 24 (44.4%) with atenolol/carvedilol, 19 (35.2%) with losartan and 7 (13%) with other antihypertensives. In group 2, 25 patients (48.2%) used one antihypertensive drug, 20 patients (37%) used two antihypertensive medications, and eight patients (14.8%) used three antihypertensive drugs. Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the data related to hemodialysis or hemodiafiltration treatment.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVariables of the study group\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003cp\u003eWithout Antihipertensives\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;52\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003cp\u003eWith Antihypertensives n\u0026thinsp;=\u0026thinsp;54\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e50.7 \u0026plusmn; 21.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59.2 \u0026plusmn; 14.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.018\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHeigt (Cm)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e153.2 \u0026plusmn; 8.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e157.4 \u0026plusmn; 10.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.025\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBMI (kg/m2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.92 \u0026plusmn; 4.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e26.18 \u0026plusmn; 4.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.160\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTreatment data (average of the last month)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePretreatment weight (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e60.44 \u0026plusmn; 14.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e66.75 \u0026plusmn; 15.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUltrafiltration (L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.022 \u0026plusmn; 0.900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.753 \u0026plusmn; 0.873\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.122\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePosttreatment weigth (kg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e57.60 \u0026plusmn; 13.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64.09 \u0026plusmn; 15.75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIDWG (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.44 \u0026plusmn; 1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.45 \u0026plusmn; 1.57\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSystolic blood pressure pretratment (mmHg)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e137.8 \u0026plusmn; 23.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e143.7 \u0026plusmn; 24.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDF volumen (L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21.92 \u0026plusmn; 3.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22.90 \u0026plusmn; 6.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.360\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDF time (min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e216.9 \u0026plusmn; 10.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e214.9 \u0026plusmn; 15.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.415\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEfecctive blood rate -QB (Ml/min)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e438.5 \u0026plusmn; 48.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e412.4 \u0026plusmn; 53.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLaboratory tests (average of the last 3 months)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemoglobine g/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10.66 \u0026plusmn; 1.82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.64 \u0026plusmn; 2.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.950\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLinfocites (u/ul)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.844 \u0026plusmn; 0.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.865 \u0026plusmn; 0.523\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.859\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaturation of transferrine (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e25.31 \u0026plusmn; 13.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.75 \u0026plusmn; 17.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFerritine (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e258.9 \u0026plusmn; 415.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e388.5 \u0026plusmn; 472.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose (Mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e131.9 \u0026plusmn; 75.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174.2 \u0026plusmn; 107.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrea (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e95.5 \u0026plusmn; 35.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e120.3 \u0026plusmn; 53.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCreatinine (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.00 \u0026plusmn; 2.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8.22 \u0026plusmn; 4.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.753\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCholesterol (Mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e189.6 \u0026plusmn; 44.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e178.3 \u0026plusmn; 41.7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.238\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTriglicerides (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e157.1 \u0026plusmn; 94.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e174.7 \u0026plusmn; 95.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.397\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumine (G/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.24 \u0026plusmn; 0.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.98 \u0026plusmn; 0.56\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTGP (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24.6 \u0026plusmn; 56.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19.4 \u0026plusmn; 13.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.518\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhosphatase alcaline (U/L)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e174.8 \u0026plusmn; 116.3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e177.4 \u0026plusmn; 114.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.915\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSodium (meq/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e134.09 \u0026plusmn; 3.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e134.60 \u0026plusmn; 4.74\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.551\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePotasium (meq/l)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5.17 \u0026plusmn; 0.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.12 \u0026plusmn; 0.83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.765\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCalcium (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.10 \u0026plusmn; 0.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.03 \u0026plusmn; 1.44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.777\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePhosphate (mg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.92 \u0026plusmn; 1.64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.11 \u0026plusmn; 1.76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.577\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParatohormone (pg/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e363.6 \u0026plusmn; 230.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e342.1 \u0026plusmn; 289.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.692\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eHDF: Hemodiafiltration. IDWG: interdialytic weight gain. HDF\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFactors associated with the use of antihypertensive agents\u003c/h2\u003e \u003cp\u003eThe 50th percentile (P50) was used to categorize the variables on a scale. The P50 values for the scale variables were as follows: IDWG, 4.925%; effective QB, 423.5 ml/min; transferrin saturation, 26.75%; glucose, 109.27 mg/dl; urea, 103.775 mg/dl; and albumin, 4.214 g/dl.\u003c/p\u003e \u003cp\u003eThe risk factors for the use of antihypertensive agents were the presence of vascular amputation, a history of smoking, the presence of a diagnosis of type 2 diabetes mellitus, a % transferrin saturation\u0026thinsp;\u0026gt;\u0026thinsp;26.75%, male sex, and hemodialysis as the treatment type.\u003c/p\u003e \u003cp\u003eA diagnosis of glomerulonephritis as the etiology of chronic renal failure, a history of never smoking, a serum ALB concentration\u0026thinsp;\u0026gt;\u0026thinsp;4.216 g/dl, an effective Qb greater than 423.5 ml/min, an IDWG greater than 4.925%, hemodiafiltration as treatment, urea\u0026thinsp;\u0026lt;\u0026thinsp;103.78 mg/dl, and fasting glucose\u0026thinsp;\u0026lt;\u0026thinsp;109.27 mg/dl were identified as statistically significant protective factors (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eRisk and protective factors for the use of antihypertensives.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eGroup 1\u003c/p\u003e \u003cp\u003eWithout Antihipertensives\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;52\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eGroup 2\u003c/p\u003e \u003cp\u003eWith Antihypertenives n\u0026thinsp;=\u0026thinsp;54\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eOR*\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e95% CI of the OR\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRisk factor's\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLegs vascular amputation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9 (16.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.241-387.216\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEx-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (18.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e11.591\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.427\u0026ndash;94.163\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eType 2 Diabetes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19 (36.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (64.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.003\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.199\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.446\u0026ndash;7.078\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTransferrine saturation\u0026thinsp;\u0026gt;\u0026thinsp;26.75%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21 (40%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (64.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.719\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.238\u0026ndash;5.972\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18 (34.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e35 (64.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.842\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.224\u0026ndash;2.772\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e34 (65.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (35.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemodialysis as treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5 (9.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16 (29.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.218\u0026ndash;2.385\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProtection factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlomerulonephritis as ethiology of CKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16 (30.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5 (9.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.005\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.077\u0026ndash;0.685\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSmokin never\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e44 (84.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e31 (57.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.245\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.097\u0026ndash;0.619\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumine\u0026thinsp;\u0026gt;\u0026thinsp;4.214 gr/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (59.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (35.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.368\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.167\u0026ndash;0.808\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEfective QB\u0026thinsp;\u0026gt;\u0026thinsp;423.5 ml/min\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (38.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.182\u0026ndash;0.869\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIDWG\u0026thinsp;\u0026gt;\u0026thinsp;4.925%\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e32 (61.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e22 (40.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.430\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.197\u0026ndash;0.936\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemodiafiltration as treatment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e47 (90.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38 (70.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.009\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.196\u0026ndash;0.947\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrea\u0026thinsp;\u0026lt;\u0026thinsp;103.78 mg/dL\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (59.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e21 (38.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.026\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.661\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.446\u0026ndash;0.979\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGlucose\u0026thinsp;\u0026lt;\u0026thinsp;109.27 mg/dl\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e31 (59.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e19 (35.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.012\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.608\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.404\u0026ndash;0.914\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eNonsignificant factors\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent-smoker\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0 (0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.339\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.014\u0026ndash;8.529\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHypertension as ethiology of CKD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6 (11.1%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.221\u0026ndash;2.138\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolycistic Kidney disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2 (3.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.482\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.628\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.101\u0026ndash;3.921\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCKD of unkonown ethiology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7 (13.0%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.468\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.274\u0026ndash;2.447\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccess fistula\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e40 (76.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39 (72.2%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.370\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.780\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.324\u0026ndash;1.877\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAccess Graft\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (7.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.91%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.226\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.024\u0026ndash;2.097\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCatheter\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8 (15.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.925\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.731\u0026ndash;5.070\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDiabetic blindness or significant retinal vascular injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6 (11.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14 (25.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.049\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.683\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.943\u0026ndash;7.638\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCancer\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (1.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.743\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.962\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.059\u0026ndash;15.798\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003e*Odds ratio for the presence of the risk factor and the use of antihypertensive drugs.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eMain results\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003eMortality and survival analysis\u003c/h2\u003e \u003cp\u003eThe group that required antihypertensive agents had a significantly greater rate of mortality, with 11 patients (21.2%) compared to 25 patients (46.3%) in the other group (P\u0026thinsp;=\u0026thinsp;0.005). On the other hand, group 1 had higher survival rates, with an HR of 2.2163 (1.125\u0026ndash;4.158) and P\u0026thinsp;=\u0026thinsp;0.0243, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig4\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The antihypertensive agent group (Group 2) had a survival time of 46 months, while Group 1 had indefinite survival, with a 70% probability of survival at 144 months at the end of the study.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eSecondary analyses\u003c/h2\u003e \u003cp\u003eThe Cox equation was used to predict the outcome of antihypertensive medication use based on survival (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). The variables were significant: age, transferrin saturation, serum albumin concentration, and history of vascular amputation of a limb or part of the limb. According to the analysis stratified by sextile, a sextile less than 141 mmHg and greater than 122 mmHg predialysis systolic blood pressure and the use of antihypertensive agents increased the risk of death [HR 4.877 (1.297\u0026ndash;18.34) P\u0026thinsp;=\u0026thinsp;0.0141]. With a predialysis systolic blood pressure of less than 105 mmH6, antihypertensive therapy increased the risk of death [HR 4.764 (1.138\u0026ndash;19.94) P\u0026thinsp;=\u0026thinsp;0.010]. No other significant associations were found according to blood pressure level (Fig.\u0026nbsp;\u003cspan refid=\"Fig5\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eVariables in the COX Equation.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"10\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eB\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSE\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eWald\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003edf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eSig.\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003eExp(B)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c9\" namest=\"c8\"\u003e \u003cp\u003e95.0% CI for Exp(B)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eLower\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eUpper\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge (Years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.035\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4.201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.040\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.072\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSaturation of Transferrine (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.028\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.014\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3.759\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.946\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlbumine (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-2.093\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.398\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e27.692\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e.057\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e.269\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVascular amputation of a leg or part of it\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.363\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e.582\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5.494\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e.019\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.909\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e12.222\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c9\" namest=\"c1\"\u003e \u003cp\u003e-2 Log Likelihood 156.9, Chi-square 42.5, df 4, Sig\u0026thinsp;\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"1\" nameend=\"c10\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eMain findings of the study\u003c/h2\u003e \u003cp\u003eThe main finding confirms the hypothesis of the study that there is more remarkable survival in the group of patients with CKD whose hypertension can be controlled without antihypertensive treatment and with the use of constant dry weight reduction measures to optimize ultrafiltration. The factors associated with the lack of control of arterial hypertension were a history of vascular amputation, a history of being an ex-smoker, being a carrier of type 2 diabetes mellitus, having a serum ferritin level greater than 26.75%, being male, and being treated with hemodialysis. The associated protective factors were having a diagnosis of glomerulonephritis as an etiology of chronic kidney disease, a history of never smoking, a serum ALB concentration greater than 4.214 g/dl, effective blood flow greater than 423.5 ml/min, and interdialytic weight gain\u0026thinsp;\u0026gt;\u0026thinsp;4.925%, hemodiafiltration as treatment, urea levels less than 103.78 mg/dl, and fasting glucose levels less than 109.2 mg/dl. According to the time-adjusted model, only four factors were associated: age, transferrin saturation, serum albumin levels, and history of vascular amputation.\u003c/p\u003e \u003cp\u003eIn the stratified analysis, differences in survival were demonstrated by the percentiles of blood pressure taken in the last month of survival or censoring. With blood pressures ranging from 141 mmHg to 122 mmHg, there is a proportional risk of death associated with the intake of antihypertensive agents. The same occurs when the blood pressure is less than 105 mmHg. These relationships could not be established with pressures greater than 141 mmHg.\u003c/p\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eImportance of the findings\u003c/h2\u003e \u003cp\u003eThese findings are significant because they suggest that a lack of blood pressure control in patients with CKD undergoing hemodiafiltration or hemodialysis, despite optimization of dry weight, may be associated with poorer survival. Adequate blood pressure control is essential for reducing the risk of cardiovascular events, such as myocardial infarction, stroke, and death. In this study, blood pressure control with ultrafiltration was possible in 49.1% of patients, with a confidence interval ranging from 39.58\u0026ndash;58.62%. This finding suggested that identifying and treating factors contributing to the lack of blood pressure control is essential. Some factors that may contribute to the lack of blood pressure control in patients with CKD include hypervolemia, malnutrition, excess transferrin saturation, and arteriolopathy, which can cause peripheral ischemia (vascular amputation).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eStudies with related findings\u003c/h2\u003e \u003cp\u003eSimilar observational studies have been presented previously [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]; however, these studies do not consider the differentiation of greater or lesser mortality between patients taking antihypertensive medications. Specifically, in patients undergoing hemodiafiltration, the CONVINCE study published in 2023 included patients who were receiving hemodiafiltration treatments and had lower mortality than were found in patients receiving hemodialysis (HR 0.77 95% CI 0.65\u0026ndash;0.93); however, it did not distinguish groups in the subanalyses of patients receiving antihypertensive treatments [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. One clinical study of 126 hemodialysis patients was randomized into two groups: the first had a systolic pressure of 110\u0026ndash;140 mmHg and intensive antihypertensive treatment, and the second had a systolic pressure of 155\u0026ndash;165 mmHg and standard treatment. The follow-up time was one year. There was no difference in mortality between the groups studied: 4 deaths in the intensive group versus 1 in the standard group (OR 4.34 95% CI 0.47-40) P\u0026thinsp;=\u0026thinsp;0.1947 [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eAlternative explanations\u003c/h2\u003e \u003cp\u003eThe study deals specifically with hemodialysis patients whose blood pressure cannot be controlled with ultrafiltration measures alone, diet, or water restriction but requires additional measures such as antihypertensive drugs. Clearly, in this group of patients with uncontrollable hypertension, dietary transgressors who did not limit their sodium and liquid intake were included, patients with malnutrition and low oncotic pressure were included, and patients with arteriolopathy were included. With clinical assessment at the bedside, an attempt was made to exclude hypovolemic patients from the group who unnecessarily took antihypertensive medications.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eClinical relevance of the findings\u003c/h2\u003e \u003cp\u003eThis study provides a methodology for continuous ultrafiltration with point-of-care dry weight. This methodology can lead to using an artificial intelligence algorithm for automated dry-weight programming. Additionally, of clinical relevance is the fact that hemodiafiltration treatment, in addition to having a clinically effective replacement volume (\u0026gt;\u0026thinsp;22 liters), requires an extracorporeal flow prescription good enough to provide adequate clearance (Qb greater than 423.5 ml/min).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eLimitations of the study\u003c/h2\u003e \u003cp\u003eSmall sample size. However, additional multicenter studies are needed to validate our results. A limitation was the need for a record of the doses of erythropoietin administered during the period that may be related to arterial hypertension. Another limitation is the lack of a bioimpedance assessment in the cases presented.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003eFuture investigations\u003c/h2\u003e \u003cp\u003eFuture studies should address dry weight obtained by impedance and its long-term relationship with antihypertensive agents.\u003c/p\u003e \u003c/div\u003e "},{"header":"Conclusions","content":"\u003cp\u003eThe findings of this study suggest that blood pressure control with active ultrafiltration measures and without the use of antihypertensive agents is an essential factor that contributes to more remarkable survival in patients with CKD in hemodiafiltration and hemodialysis programs. The use of antihypertensive drugs in patients on hemodiafiltration and hemodialysis programs, with pressures between 141 and 122 mmH and less than 105 mmHg, can be harmful.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eCKD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eChronic kidney disease\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eHR\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHazard ratio\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePOCW\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePoint of Care Dry Weight\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003eData availability statement\u003c/p\u003e\n\u003cp\u003eThe data supporting this study are included in the supporting materials.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eWe thank the Ecuadorian Society of Nephrology for facilitating connections between cooperating centers. In memory of Doctor H\u0026eacute;ctor Perez-Grovas (1951-2022).\u003c/p\u003e\n\u003cp\u003eFunding:\u003c/p\u003e\n\u003cp\u003eThe authors of this article funded the costs of this research. Laboratory tests are part of the usual activity of hemodialysis units in Ecuador and do not represent costs for patients or researchers.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026lsquo; contributions\u003c/p\u003e\n\u003cp\u003eFranklin Geovany Mora-Bravo: Conceptualization, Methodology, validation, formal analysis, investigation, data curation, writing-original.\u003c/p\u003e\n\u003cp\u003ePamela Tatiana Morales Torres: Sofware, resources, supervision, project administration, funding acquisition.\u003c/p\u003e\n\u003cp\u003eNelson Rojas Campoverde: investigation, resources, data curation, writing-original.\u003c/p\u003e\n\u003cp\u003eGuillermina Luc\u0026iacute;a Blum Carcelen: Resources, supervision, investigation, resources, data curation, writing-original.\u003c/p\u003e\n\u003cp\u003eJuan Cristobal Santacruz Mancheno: Resources, investigation, resources, data curation, writing-original.\u003c/p\u003e\n\u003cp\u003e\u0026Aacute;ngel Crist\u0026oacute;bal Santacruz Tipanta: Conceptualization, Methodology, resources.\u003c/p\u003e\n\u003cp\u003eHector Perez-Grovas: Conceptualization, Methodology.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics committee approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe Ethics Committee of the Ecuatorian Society of Nephrology approved this study. Informed consent was obtained from all participating subjects.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no conflicts of interest.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSymonides B, Lewandowski J, Małyszko J. Resistant hypertension in dialysis. Nephrol Dial Transplant. 2023;38(9):1952\u0026ndash;1959. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1093/ndt/gfad047\u003c/span\u003e\u003cspan address=\"10.1093/ndt/gfad047\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. PMID: 36898677.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eUlrich C, Canim Z, Herberger E, Girndt M, Fiedler R. Inflammation in Hypervolemic Hemodialysis Patients: The Roles of RelB and Caspase-4. 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PMID: 27661097; PMCID: PMC5861571.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBlankestijn PJ, Vernooij RWM, Hockham C, Strippoli GFM, Canaud B, Hegbrant J, Barth C, Covic A, Cromm K, Cucui A, Davenport A, Rose M, T\u0026ouml;r\u0026ouml;k M, Woodward M, Bots ML, CONVINCE Scientific Committee Investigators. Effect of Hemodiafiltration or Hemodialysis on Mortality in Kidney Failure. N Engl J Med. 2023;389(8):700\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMoa2304820\u003c/span\u003e\u003cspan address=\"10.1056/NEJMoa2304820\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e. Epub 2023 Jun 16. PMID: 37326323.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMiskulin DC, Gassman J, Schrader R, Gul A, Jhamb M, Ploth DW, Negrea L, Kwong RY, Levey AS, Singh AK, Harford A, Paine S, Kendrick C, Rahman M, Zager P. BP in Dialysis: Results of a Pilot Study. J Am Soc Nephrol. 2018;29(1):307\u0026ndash;16. Epub 2017 Dec 6. PMID: 29212839; PMCID: PMC5748902.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Antihypertensives, Hemodiafiltration, Mortality, Point of Care Dry Weight, Survival","lastPublishedDoi":"10.21203/rs.3.rs-4054177/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4054177/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eHigh blood pressure is a prevalent condition in patients with chronic kidney disease on hemodialysis. Adequate control of high blood pressure is essential to reduce deaths in this group of patients. The present study aimed to observe mortality prospectively in a group of patients in hemodialysis and hemodiafiltration programs in whom the use of antihypertensives was optimized with the point of care dry weight (POCW) technique.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThe present observational, prospective study was carried out at the Pafram Hemodiafiltration Unit in Morona Santiago, Ecuador, and the Hemodialysis Unit of the Fundaci\u0026oacute;n Renal del Ecuador in Guayaquil, Ecuador, from August 2019 to December 2023. Patients who were receiving hemodiafiltration were included. Weight was optimized with POCW. Group 1 included patients whose antihypertensive agents were not required to control blood pressure with a value less than 150/85 mmHg predialysis at eight weeks of POCW. In group 2, the patients required antihypertensive therapy. Clinical data, demographic data, mortality data, treatment descriptions, and routine laboratory test results during dialysis were included. The sample was nonprobabilistic. Survival analysis was carried out for the study groups. The log-rank test (Mantel-Cox) was used for survival comparisons.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eThe study included 106 patients. Optimal blood pressure control without antihypertensive treatment was achieved in 52 patients (49.1%) (Group 1). In 54 patients (50.9%), antihypertensive agents were required (Group 2). There was more significant mortality in the group that received antihypertensives: 11 patients in group 1 (21.2%) versus 25 patients in group 2 (46.3%) (P\u0026thinsp;=\u0026thinsp;0.005). Survival was more significant in group 1, with an HR of 2.2163 (1.125\u0026ndash;4.158) (P\u0026thinsp;=\u0026thinsp;0.0243).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eBlood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs.\u003c/p\u003e","manuscriptTitle":"Blood pressure control with active ultrafiltration measures and without the use of antihypertensives is essential for survival in patients with CKD in hemodiafiltration and hemodialysis programs. A prospective multicenter observational study.","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-27 00:31:03","doi":"10.21203/rs.3.rs-4054177/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-09-09T15:02:54+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-09-05T10:24:44+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274241023123800982691869611267767463571","date":"2024-09-04T11:29:46+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-05-29T03:09:36+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"191966012650082768549750124484502897971","date":"2024-05-15T13:54:17+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"44987114700048783943403590507600737438","date":"2024-05-15T09:29:14+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-05-15T07:05:25+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-05-15T04:57:53+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-02-24T07:06:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-02-24T06:58:37+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Nephrology","date":"2024-02-16T07:56:37+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-nephrology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bnep","sideBox":"Learn more about [BMC Nephrology](http://bmcnephrol.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bnep/default.aspx","title":"BMC Nephrology","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9fa58d35-557a-4dff-9d28-b9949269b3d0","owner":[],"postedDate":"July 27th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-01-20T16:04:55+00:00","versionOfRecord":{"articleIdentity":"rs-4054177","link":"https://doi.org/10.1186/s12882-025-03948-0","journal":{"identity":"bmc-nephrology","isVorOnly":false,"title":"BMC Nephrology"},"publishedOn":"2025-01-17 15:57:04","publishedOnDateReadable":"January 17th, 2025"},"versionCreatedAt":"2024-07-27 00:31:03","video":"","vorDoi":"10.1186/s12882-025-03948-0","vorDoiUrl":"https://doi.org/10.1186/s12882-025-03948-0","workflowStages":[]},"version":"v1","identity":"rs-4054177","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4054177","identity":"rs-4054177","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}
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