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 > or = 150 mmHg, diastolic blood pressure > or = 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.