Abstract: Objective To assess the medium and long term efficacy of hemodialysis combined with hemoperfusion in the treatment of maintenance hemodialysis (MHD) patients with refractory hypertension. Methods Seventy- five MHD patients with persistent and refractory hypertension for more than 6 months were randomly divided into two groups: hemoperfusion (HP) group (n=45) and control group (n=30). In control group, hemodialysis was performed 3 times a week and hemodiafiltration was performed once every 2 weeks. In HP group, hemoperfusion was performed once every 2 weeks in addition to the therapeutic protocol
in control group. Plasma rennin, angiotensinⅡ (ATⅡ) and aldosterone were measured by radioimmunoassay. Blood pressure was measured before and after the treatment. Result ①Plasma rennin, ATⅡ and aldosterone changed insignificantly after the treatment for 0, 3, 6 and 12 months in control group. ②With continuing the treatment, plasma rennin and systolic blood pressure (values before and after the treatment), diastolic blood pressure (value before the treatment), plasma AT Ⅱ and aldosterone (values after the treatment) decreased gradually in HP group (P＜0.01 or 0.05). Plasma ATⅡ and aldosterone after the treatment for 6 months and 12 months were significantly lower than those at the beginning and after the treatment for 3 months (P＜0.01). ③After the treatment for 6 months and 12 months, plasma rennin, ATⅡ, aldosterone and blood pressure were lower in HP group than in control group (P＜0.01 or 0.05). ④Plasma rennin, ATⅡ and aldosterone correlated with mean arterial pressure before and after the treatment. Conclusion Hemodialysis combined with hemoperfusion with an appropriate frequency and for a medium or long period is a safe, convenient, and effective approach for MHD patients with refractory hypertension.

Key words: maintenance hemodialysis (MHD), hemoperfusion, resistant hypertension