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Therapeutic Education's Role in the Management of Hypertension in Chronic Hemodialysis Patients

DOI: 10.5402/2013/481595

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Abstract:

The prevalence of hypertension remains high in hemodialysis (HD) patients, leading to a considerable morbimortality. The “dry weight method (DW),” established by Scribner, presents an undeniable interest in the management of hypertension in HD patients. Aim. The aim of our work was to determine the prevalence and risk factors (RFs) of hypertension in our chronic HD patients and try to reduce it by using a therapeutic education (TE) strategy based on Scribner’s recommendations. Patients and Methods. We led an interventional prospective study in three phases. In phase 1, we determined the prevalence of hypertension. In phase 2, hypertensive patients benefited of a TE strategy. In phase 3, we evaluated the effects of our TE. Results. Hypertension was noted in 57 patients. RFs for hypertension included age, important interdialytic weight gain (IDWG), noncompliance to the dietary rules, and a rhythm of 2 sessions of dialysis per week. The use of a TE strategy enabled us to correct hypertension in some of our HD patients. Conclusion. A TE strategy improved the hypertension rate in our HD unit. This success could not be conceived without an educational effort supported by the whole medical team. 1. Introduction The prevalence of hypertension remains high in hemodialysis (HD) patients, leading to a considerable morbimortality, and an unsatisfactory quality of life. The “dry weight method (DW),” established by Scribner, presents an undeniable interest in the management of hypertension in HD patients [1]. It is based on a gradual reduction of dry weight (DW), respect of sodium balance during the dialysis session, performance of sufficiently long dialysis sessions, a low sodium diet, and the gradual withdrawal of antihypertensive drugs [1]. Our study was conducted in three stages, each with distinct objectives. The aim in the first stage was to determine the prevalence of hypertension and its risk factors within our population of chronic hemodialysis patients. Then, in the second stage, we aimed to lower the blood pressure levels of our patients by adopting a therapeutic education (TE) strategy based on Scribner’s recommendations. Finally, we evaluated the effects of our nonpharmacological treatment and our educational involvement. 2. Patients and Methods Our interventional prospective study was carried out in three months, from October to December 2011, and in three stages. It enrolled 93 chronic hemodialysis patients from our hemodialysis unit. The first stage consisted of an assessment of the epidemiological context, a determination of the prevalence of

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