WASHINGTON—Patients on hemodialysis (HD) patients who experience an increase in their extracellular water to total body water ratio (ECW/TBW) tend to develop post-dialysis hypertension and, in turn, heighten their risks for early death, investigators reported at the American Society of Nephrology’s Kidney Week 2019 meeting.

Of 254 prevalent HD patients (mean age 59 years; 38% female), 29.1% had an increase in systolic blood pressure (SBP) of 10 mm Hg or more after a midweek dialysis session based on bioimpedance analyses, Hyeong cheon Park, MD, of Gangnam Severance Hospital in South Korea, and colleagues reported.

Compared with the nonhypertensive group, the hypertensive group was significantly older (64.3 vs 56.8 years) and more likely to be using diuretics (45.9% vs 29.4%). The hypertensive group also had a higher ECW/TBW ratio (0.400 vs 0.389), lower phase angle (4.4 vs 5.3), higher brain natriuretic peptide (1034.1 vs 519.0 pg/mL), and lower albumin (3.8 vs 4.0 mg/dL). Increased systolic blood pressure significantly correlated with increased ECW/TBW. In multiple logistic regression analysis, ECW/TBW was the only independent risk factor affecting post-dialysis hypertension.

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Individuals with post-dialysis hypertension had significantly greater risks for all-cause mortality within 4 years than more normotensive patients (30.2% vs 15.9%).

“HD patients who experience frequent increase in post-dialysis systolic blood pressure should be reassessed for their volume status and target dry weights, with emphasis on the ECW/TBW ratio,” Dr Park’s team concluded.


Park HY, Jung KS, Lee M, et al. Overhydration Is an Independent Risk Factor for Postdialysis Hypertension and Predicts Mortality in Hemodialysis Patients. Presented at: Kidney Week 2019. November 5-10, 2019. Washington DC. Poster TH-PO185.