An observational study on management of refractory hypertension in patients with chronic kidney disease stage-V on maintenance haemodialysis

Refractory hypertension (RfHTN) presents a challenge in managing patients with chronic kidney disease (CKD) and undergoing maintenance haemodialysis (MHD). Hypertension exacerbates kidney function loss and adversely impacts CKD patients' quality of life. In order to enhance the quality of life for patients with stage-V chronic kidney disease (CKD) receiving maintenance hemodialysis, the study set out to detect, define, and treat refractory hypertension (RfHTN). A six-month prospective observational study was carried out at a tertiary care hospital's outpatient dialysis unit. Patients with CKD on MHD and uncontrolled blood pressure (BP) despite >5 antihypertensive medications were enrolled. BP monitoring pre- and post-dialysis was performed thrice weekly. The effect of antihypertensive agents was evaluated using symptom frequency, target BP, medication adherence (MMAS-8 Score), kidney disease quality of life (KDQOL-36 score), and adverse effects monitoring. 50 participants were enrolled, with a higher percentage of male patients (60%). Significant differences in systolic BP and pulse rate were observed pre and post-dialysis. In our research, approximately 48% of the participants fell within the adult age range (25 to 65 years), while only 2% were classified as elderly, aged (65 years and above). In the BMI distribution, a significant portion of patients showed diverse weight categories: 18% were underweight, 64% fell within the normal weight range, 16% were overweight, and 2% were classified as obese.A notable variation in hemoglobin levels across all patients was reported, which might contribute to poor kidney function and challenges in managing blood pressure among them. A significant contrast was noted in the MMAS-8 score between the initial evaluation and the subsequent follow-up assessments. a significant variance was noted in the MMAS-8 score between the initial and follow-up evaluations. Medication adherence was found to correlate with improved BP control. Higher KDQOL-36 scores indicated better health-related quality of life. In managing hypertension in MHD patients, angiotensin II receptor blockers (ARBs) proved effective, alongside dietary salt restrictions and appropriate diuretic therapy. Hypertensive MHD patients face increased cardiovascular and renal risks, emphasizing the importance of maintaining normal BP.