#2371 Home dialysis and hypertension: evaluating the role of the dialysate

Abstract Background and Aims Home hemodialysis has gained attention as an effective alternative to in-center dialysis, offering patients more freedom and clinical benefits with lower cost. Several studies have associated the implementation of low-flow but more frequent hemodialysis protocols with improvements in the cardiovascular profile of our patients, observing a better blood pressure control together with other parameters. Among the available alternatives for home dialysis in our unit, we can choose between either bicarbonate-based or lactate-based dialysis, depending on the buffer used for the bath. Based on our subjective observation, we have the impression that the patients on a lactate-based dialysis have a better blood pressure control, despite the fact that the final sodium contribution is the same in both baths. However, we wanted to explore whether this empirical perception could be supported by objective data. The aim of this study was to evaluate the effect of the different types of dialysate on blood pressure control after one year in our home hemodialysis program. Method We conducted a retrospective, observational, single-center study, including all patients who had been in our home hemodialysis program for at least one year, since 2018 to the present day. A total of 19 patients were included. We recorded the number and dosage of antihypertensive medications at baseline and after one year in the program, and classified them based on whether they had decreased (0), remained the same (1), or increased (2) in number or dosage. We then performed the Mann-Whitney U test to compare whether there were differences in these changes based on the dialysis bath. Results The basic characteristics of the analyzed patients are showed in Table 1. A total of 13 patients had a bicarbonate-based dialysis, among which only 3 were able to reduce the number or dosage of antihypertensive drugs after one year in our home dialysis program. The rest either remained the same (5) or needed a treatment enhance (5). Amid the lactate-based group, also 3 were able to diminish the antihypertensive treatment, 2 did not had a medication change and only 1 required an increase in therapy. Although there appears to be a trend supporting our hypothesis, the Mann-Whitney U test comparing changes in antihypertensive medications between the two groups (buffered with lactate or bicarbonate) was not statistically significant (U = 26.0, P = 0.227). Conclusion In our sample, we observed a trend in which more patients on bicarbonate-based dialysis tend to maintain or increase antihypertensive medications compared to those using lactate. However, these differences were not statistically significant, likely due to the small sample size. Therefore, we consider that it may be worth exploring the pathophysiological mechanisms that may lead to this phenomenon, for which further studies will be necessary.