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Extracellular fluid management and hypertension in urban dwelling versus rural dwelling hemodialysis patients

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Abstract

Background

Rural-dwelling hemodialysis patients have less frequent contact with nephrologists than urban-dwelling patients, and are known to have higher mortality. We hypothesized that rural-dwelling hemodialysis patients would have more evidence of poorly controlled extracellular fluid volume (ECVF) than otherwise similar urban-dwellers.

Methods

We studied prevalent hemodialysis patients within a single renal program in Alberta, Canada and assessed ECFV using bioimpedance spectroscopy (BIS). Our primary outcome was impedance vector length (ohm/m) as assessed by BIS using the Xitron Hydra 4200 device, where shorter vector length indicated poorer ECFV control. Because poor ECFV control can lead to hypertension, we also assessed pre- and post-dialysis blood pressure. We measured outcomes at baseline.

Results

We studied 228 hemodialysis patients, of whom 115 (50.4 %) and 113 (49.6 %) were urban- and rural-dwelling, respectively. There were no differences in volume control in urban versus rural participants; odds ratio (OR) for vector length in the lowest sex-specific quartile of vector length was 0.93 (95 % CI 0.54, 1.59) after adjusting for age, sex, diabetic status, years since dialysis initiation and phase angle. The odds of very poor blood pressure control (pre-dialysis blood pressure ≥180/100) did not differ between urban and rural participants [fully adjusted OR 0.96 (0.36, 2.60)].

Conclusions

Differences in ECFV control do not appear to explain higher mortality among remote- and rural- dwelling hemodialysis patients, compared to urban-dwellers.

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Acknowledgments

The authors of this report are grateful to the study coordinators: Nancy Ruholl, Nasreen Ahmad and Lori Piquette; research assistants Yuanchen Liu, Lois Hannam, Brian Nadler, Tim Chan, Evelyn Chan, and Somaya Zahran; and to all of the participants in this study.

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Authors and Affiliations

  1. University of Calgary, 7th Floor, TRW Building, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada

    Marcello Tonelli, Anita Lloyd, Neesh Pannu, Scott Klarenbach, Pietro Ravani, Kailash Jindal, Jennifer MacRae, Larry Unsworth, Braden Manns & Brenda Hemmelgarn

Authors
  1. Marcello Tonelli
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  2. Anita Lloyd
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  3. Neesh Pannu
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  4. Scott Klarenbach
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  5. Pietro Ravani
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  6. Kailash Jindal
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  7. Jennifer MacRae
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  8. Larry Unsworth
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  9. Braden Manns
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  10. Brenda Hemmelgarn
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Correspondence to Marcello Tonelli.

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Funding

This work was supported by the Canadian Institutes of Health Research.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Tonelli, M., Lloyd, A., Pannu, N. et al. Extracellular fluid management and hypertension in urban dwelling versus rural dwelling hemodialysis patients. J Nephrol 31, 103–110 (2018). https://doi.org/10.1007/s40620-016-0337-y

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  • DOI: https://doi.org/10.1007/s40620-016-0337-y

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