A RECENT study revealed that managing blood pressure through active ultrafiltration measures rather than antihypertensive medications is crucial for improving survival rates among chronic kidney disease (CKD) patients undergoing haemodialysis or hemodiafiltration.
The prospective observational study was conducted at dialysis centres in Ecuador between August 2019 and December 2023 and included 106 patients. Participants were divided into two groups: those who achieved optimal blood pressure control without the use of antihypertensives (Group 1, 49.1%) and those who required antihypertensive medications to manage their blood pressure (Group 2, 50.9%).
Over the study period, Group 1 experienced a significantly lower mortality rate (21.2%) compared to Group 2 (46.3%). Survival analysis demonstrated that patients who managed their blood pressure without medication had better long-term outcomes, with a hazard ratio of 2.22 (P = 0.024).
The study used the point-of-care dry weight (POC-DW) technique to optimise fluid removal during dialysis, achieving systolic blood pressure targets of less than 150 mmHg pre-dialysis and less than 130 mmHg post-dialysis, with minimal peridialytic blood pressure fluctuations.
These findings suggest that non-pharmacological strategies, particularly careful fluid management through ultrafiltration, may reduce reliance on antihypertensives and improve survival rates in dialysis patients. The results underscore the importance of tailored dialysis care and ongoing monitoring to address the unique challenges of hypertension in CKD patients.
Aleksandra Zurowska, EMJ
Reference
Mora-Bravo FG et al. Blood pressure control with active ultrafiltration measures and without antihypertensives is essential for survival in hemodiafiltration and hemodialysis programs for patients with CKD: a prospective observational study. BMC Nephrol. 2025;DOI: 10.1186/s12882-025-03948-0.
