Extracellular fluid management and hypertension in urban dwelling versus rural dwelling hemodialysis patients.

Abstract:

BACKGROUND:Rural-dwelling hemodialysis patients have less frequent contact with nephrologists than urban-dwelling patients, and are known to have higher mortality. We hypothesized that rural-dwelling hemodialysis patients would have more evidence of poorly controlled extracellular fluid volume (ECVF) than otherwise similar urban-dwellers. METHODS:We studied prevalent hemodialysis patients within a single renal program in Alberta, Canada and assessed ECFV using bioimpedance spectroscopy (BIS). Our primary outcome was impedance vector length (ohm/m) as assessed by BIS using the Xitron Hydra 4200 device, where shorter vector length indicated poorer ECFV control. Because poor ECFV control can lead to hypertension, we also assessed pre- and post-dialysis blood pressure. We measured outcomes at baseline. RESULTS:We studied 228 hemodialysis patients, of whom 115 (50.4 %) and 113 (49.6 %) were urban- and rural-dwelling, respectively. There were no differences in volume control in urban versus rural participants; odds ratio (OR) for vector length in the lowest sex-specific quartile of vector length was 0.93 (95 % CI 0.54, 1.59) after adjusting for age, sex, diabetic status, years since dialysis initiation and phase angle. The odds of very poor blood pressure control (pre-dialysis blood pressure ≥180/100) did not differ between urban and rural participants [fully adjusted OR 0.96 (0.36, 2.60)]. CONCLUSIONS:Differences in ECFV control do not appear to explain higher mortality among remote- and rural- dwelling hemodialysis patients, compared to urban-dwellers.

journal_name

J Nephrol

journal_title

Journal of nephrology

authors

Tonelli M,Lloyd A,Pannu N,Klarenbach S,Ravani P,Jindal K,MacRae J,Unsworth L,Manns B,Hemmelgarn B

doi

10.1007/s40620-016-0337-y

subject

Has Abstract

pub_date

2018-02-01 00:00:00

pages

103-110

issue

1

eissn

1121-8428

issn

1724-6059

pii

10.1007/s40620-016-0337-y

journal_volume

31

pub_type

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