Utility of bioimpedance spectroscopy (BIS) in the management of refractory hypertension in patients with chronic kidney disease (CKD)

Expansion of extracellular volume (ECV) is a frequent cause of resistant hypertension (RHT) in patients with chronic kidney disease (CKD). The aim of this exploratory study was that of applying bioimpedance spectroscopy (BIS) for the identification of CKD patients with RHT and expansion of ECV, whil...

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Published in:Nephrology, dialysis, transplantation dialysis, transplantation, 2012-12, Vol.27 Suppl 4 (suppl 4), p.iv31-iv35
Main Authors: Verdalles, Ursula, de Vinuesa, Soledad García, Goicoechea, Marian, Quiroga, Borja, Reque, Javier, Panizo, Nayara, Arroyo, David, Luño, José
Format: Article
Language:English
Subjects:
Aged
Dielectric Spectroscopy
Diuretics - therapeutic use
Female
Humans
Hypertension - diagnosis
Hypertension - drug therapy
Hypertension - etiology
Male
Pilot Projects
Renal Insufficiency, Chronic - complications
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Summary:Expansion of extracellular volume (ECV) is a frequent cause of resistant hypertension (RHT) in patients with chronic kidney disease (CKD). The aim of this exploratory study was that of applying bioimpedance spectroscopy (BIS) for the identification of CKD patients with RHT and expansion of ECV, while trying to control blood pressure (BP) using an intensification of diuretic treatment. We included 50 patients with RHT and CKD who underwent BIS. In order to control BP, diuretic treatment was intensified in those patients with expansion of the ECV. In all other cases, another antihypertensive drug was added. The mean age was 68.2 ± 10.4 years, 68% were male and 58% were diabetic. The mean estimated glomerular filtration rate (eGFR) was 50.7 ± 22.4 mL/min/1.72 m(2). Baseline systolic BP was 167.2 ± 8.6 mmHg and diastolic BP was 84.8 ± 9.5 mmHg. The mean number of antihypertensive drugs received was 3.8 ± 0.9. Expansion of ECV was recorded in 30 (60%) patients and was more frequent in diabetics and in patients with more albuminuria. At 6 months of follow-up, a decline of 21.4 ± 7.1 mmHg was observed in systolic BP in the patients with expansion of ECV, compared with a decrease of 9.4 ± 3.4 mmHg in the normal ECV group (P < 0.01). We did not find differences in the decrease in diastolic BP between the groups. Nine patients (30%) with ECV expansion who increased diuretic therapy reached the target blood pressure (BP) of
ISSN:0931-0509
1460-2385
DOI:10.1093/ndt/gfs420