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Innere Medizin 1. Mai 2006

Acquired cystic kidney disease and arterial hypertension in hemodialysis patients

BACKGROUND: Acquired cystic kidney disease (ACKD) and arterial hypertension (AH) are both frequent complications in hemodialysis (HD) patients. Until now, AH has not been described as a complication of ACKD. PATIENTS AND METHODS: Our study included 86 HD patients (46 men and 40 women; mean age 51.3 years; mean duration of HD treatment 55.3 months). Their native kidneys were examined with an ATL-HDI 3000 ultrasound device (2–4 MHz convex probe). Depending on the number of cysts in the kidney, the manifestations were divided into three grades: grade 0: no cysts; grade 1: fewer than ten cysts in both kidneys; grade 2: more than ten cysts in both kidneys. Blood pressure was measured 30 minutes before and after HD. Mean one-month values were analyzed. AH was defined as systolic blood pressure ≥ 150 mmHg, diastolic blood pressure ≥ 90 mmHg and/or antihypertensive treatment. The diameter of the inferior vena cava (indicator of dry weight) was measured with the same ultrasound device as the kidneys three hours after HD. RESULTS: ACKD was present in 48 (55.8%) patients, there was no statistically significant difference regarding sex. Twenty-four (50%) patients had grade 1 ACKD and 24 (50%) grade 2 ACKD. Sixty-eight (79.1%) patients suffered from AH, which was significantly more common among the men (P = 0.048). AH was detected before HD in 68 (79.1%) patients and in 54 (62.8%) patients also after HD. Thirty-nine (45.3%) patients suffered simultaneously from ACKD and AH; 22 (56.4%) of them were men and 17 (43.6%) women. No significant correlation between AH and ACKD was established. The prevalence and grade of ACKD were significantly associated with the duration of dialysis treatment (P < 0.01). Multiple regression analysis detected a significant correlation only between AH and the diameter of the inferior vena cava (P < 0.05). CONCLUSIONS: ACKD is common in HD patients. Its prevalence and grade increase with the duration of dialysis treatment. ACKD is not associated with AH. There is a correlation between the diameter of the inferior vena cava, as a factor of circulating fluid volume, and AH in HD patients.

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