Twenty four-hour ambulatory blood pressure monitoring and lipid levels before, 3, 6 and 12 months after the onset of hemodialysis in chronic kidney disease patients: a pilot study.

Background: Twenty four-hour ambulatory blood pressure (BP) monitoring (ABPM) is being increasingly used to evaluate the effectiveness of antihypertensive medications. We aimed to to investigate the incidence of "non-dippers" in ESRD patients before, as well after the initiation of hemodialysis, to evaluate whether start of hemodialysis is associated with a reduction in the use of antihypertensive drugs, and to correlate 24-hour ABPM with serum lipid levels, the use of lipid-lowering drugs (statins) and the development of the Metabolic Syndrome (MetS) in these patients.

Methods: Thirty patients scheduled to initiate hemodialysis (glomerular filtration rate <15 ml/min/1.73m(2)) were prospectively recruited. Twenty four-hour ABPM and lipid levels were recorded before (T0), as well as 3 (T1), 6 (T2) and 12 (T3) months after hemodialysis onset.

Results: A progressively significant (p=0.025) decrease in the use of antihypertensive medications was observed in 26 of 30 patients throughout the study, whereas the remaining four patients were not hypertensive during the same period. There was a progressive increase in the use of statins for the management of dyslipidemia (p=0.015). This increase in statin use was coupled with an increase in the prevalence of the MetS in the study population (p=0.040). Patients with daily BP <135/85 mm Hg had a lower incidence of new MetS compared with patients with daily BP >135/85 mm Hg (p=0.053).

Conclusions: Patients initializing hemodialysis demonstrate a progressively increased incidence of dyslipidemia and MetS, as well as a reduction in the use of antihypertensive drugs. Optimal management of BP and dyslipidemias is essential to reduce the high cardiovascular morbidity and mortality rates in this high-risk population.