Hemofiltration as a treatment for "dialysis-resistant" hypertension and hypotensive hyperhydration.

Normalization of blood pressure cannot be achieved in about 5% of patients with chronic renal insufficiency by fluid and sodium extraction on dialysis. An accompanying high plasma renin activity has, until now, been an indication for bilateral nephrectomy. In a group of 8 patients, treated since 1974 by hemofiltration, 3 had been originally considered for bilateral nephrectomy. However, through this treatment their blood pressure was normalized. The extraction of large quantities of fluid was tolerated by the patients; they did not have side effects such as muscle cramps or vascular collapse. Large quantities of fluid can also be removed by hemofiltration from hyperhydrated normotensive patients without hypotensive reactions. The present results show that the response of blood pressure to the extraction of a definite amount of fluid by hemofiltration is dependent upon the starting blood pressure: the higher the blood pressure value at the start of hemofiltration, the greater is the effect of dehydration o...