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Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP): A Randomized, Controlled Trial
Open accessAbstract
Volume excess is thought to be important in the pathogenesis of hypertension among hemodialysis patients. To determine whether additional volume reduction will result in improvement in blood pressure (BP) among hypertensive patients on hemodialysis and to evaluate the time course of this response, we randomly assigned long-term hypertensive hemodialysis patients to ultrafiltration or control groups. The additional ultrafiltration group (n=100) had the dry weight probed without increasing time or duration of dialysis, whereas the control group (n=50) only had physician visits. The primary outcome was change in systolic interdialytic ambulatory BP. Postdialysis weight was reduced by 0.9 kg at 4 weeks and resulted in −6.9 mm Hg (95% CI: −12.4 to −1.3 mm Hg; P =0.016) change in systolic BP and −3.1 mm Hg (95% CI: −6.2 to −0.02 mm Hg; P =0.048) change in diastolic BP. At 8 weeks, dry weight was reduced 1 kg, systolic BP changed −6.6 mm Hg (95% CI: −12.2 to −1.0 mm Hg; P =0.021), and diastolic BP changed −3.3 mm Hg (95% CI: −6.4 to −0.2 mm Hg; P =0.037) from baseline. The Mantel-Hanzel combined odds ratio for systolic BP reduction of ≥10 mm Hg was 2.24 (95% CI: 1.32 to 3.81; P =0.003). There was no deterioration seen in any domain of the kidney disease quality of life health survey despite an increase in intradialytic signs and symptoms of hypotension. The reduction of dry weight is a simple, efficacious, and well-tolerated maneuver to improve BP control in hypertensive hemodialysis patients. Long-term control of BP will depend on continued assessment and maintenance of dry weight.
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“During the last two decades, HBPM has been used increasingly in clinical hypertension research [17,155,267–273].”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [273]
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“During the last two decades, HBPM has been used increasingly in clinical hypertension research [17,155,267–273].”
From Home blood pressure monitoring: methodology, clinical relevance and practical application: a 2021 position paper by the Working Group on Blood Pressure Monitoring and Cardiovascular Variability of the European Society of Hypertension (2021) · cites this paper as [269]
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“0 kg, gradual dry weight reduction resulted in an additional w7 mm Hg greater reduction in ambulatory BP at 8 weeks.(181) However, adverse events including hypotension and seizures were noted with dry weight probing; thus, more gradual reductions may be better tolerated.”
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Metadata
- Authors
- Agarwal, R., Alborzi, P., Satyan, S., & Light, R. P.
- Affiliations
- Richard L. Roudebush VA Medical Center (US)
- Venue
- Hypertension
- Published
- 2009-03
- Volume
- 53
- Issue
- 3
- Pages
- 500-507
- ISSN
- 0194-911X (ISSN-L)
- 1524-4563
- PMC
- PMC2679163
- OpenAlex
- W2115611820
- Cited by
- 349
- References
- 35
- Citations by year
- 2026: 7 · 2025: 15 · 2024: 12 · 2023: 17 · 2022: 19 · 2021: 22 · 2020: 21 · 2019: 19 · 2018: 20 · 2017: 22 · 2016: 22 · 2015: 26 · 2014: 20 · 2013: 16 · 2012: 32
- FWCI
- 20.97
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Hypertension (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- IUScholarWorks (Indiana University) (submittedVersion)
- Funders
- Dialysis Clinics
- U.S. Public Health Service (5R01-NIDDK062030-05)
- National Institute of Diabetes and Digestive and Kidney Diseases (R01DK062030)
- Topics
- Health Sciences › Medicine › Nephrology › Dialysis and Renal Disease Management
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Blood Pressure and Hypertension Studies
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Keywords
- dry weight reduction, ultrafiltration, blood pressure control, hypotension, quality of life, dialysis
- MeSH terms
- Adult, Aged, Blood Pressure, Diastole, Female, Renal Dialysis, Humans, Hypertension, Kidney Failure, Chronic, Male, Middle Aged, Prospective Studies, Quality of Life, Systole, Time Factors, Weight Loss, Hemodiafiltration
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