Effects of continuous renal replacement therapy on refractory hypertension in maintenance hemodialysis patients

Zhu Yuan; Zhang Xiao-dong; Song Jie; Li Hui

doi:10.3969/j.issn.2095-4344.2014.18.020

Abstract：BACKGROUND:About 10%-49%of maintenance hemodialysis patients are accompanied by refractory hypertension and common drug therapy is ineffective. Continuous renal replacement therapy could clear the middle and giant molecule toxins in the blood plasma of patients, it is theoretical y treat refractory hypertension through reducing the toxin levels. <br> OBJECTIVE:To observe the effect of continuous renal replacement therapy on maintenance hemodialysis patients with refractory hypertension. <br> METHODS:A total of 45 maintenance hemodialysis patients with refractory hypertension were randomly divided into two groups, hemodialysis group (n=22) and continuous blood purification group (n=23). Hemodialysis group underwent conventional hemodialysis treatment. Continuous blood purification group underwent conventional hemodialysis therapy, and treatment of continuous blood purification weekly. <br> RESULTS AND CONCLUSION:After 3 months of treatment, the renin activity, endothelin, angiotensin II, C-reactive protein, interleukin-6, and tumor necrosis factor-αlevels in continuous blood purification group were significantly lower than the levels before the experiment, while 24-hour mean blood pressure levels were significantly decreased (P<0.05). In hemodialysis group, renin activity, endothelin, angiotensin II, C-reactive <br> protein, interleukin-6, and tumor necrosis factor-αlevels and 24-hour mean blood pressure did not change (P>0.05). After the test, continuous blood purification group showed significantly lower levels of the above index than the hemodialysis group (P<0.05). Continuous renal replacement therapy plus hemodialysis significantly reduce the blood pressure in maintenance hemodialysis patients with refractory hypertension, the potential mechanisms are mediated by lowering the middle and giant molecule toxin as wel as inflammatory factor in plasma.