A Comparative Study of Short-Term Blood Pressure Variability in Hemodialysis Patients with and without Intradialytic Hypertension

Abstract

Background: Short-term blood pressure (BP) variability (BPV) is associated with increased cardiovascular risk in hemodialysis. Patients with intradialytic hypertension have high risk of adverse outcomes. Whether BPV is increased in these patients is not clear. The purpose of this study was to compare short-term BPV in patients with and without intradialytic hypertension. Methods: Forty-one patients with and 82 patients without intradialytic hypertension (intradialytic SBP rise ≥10 mm Hg to > 150 mm Hg) matched in a 1: 2 ratio for age, sex, and hemodialysis vintage were included. All subjects underwent 48-h ambulatory BP monitoring during a regular hemodialysis and the subsequent interdialytic interval. Brachial and aortic BPV were calculated with validated formulas and compared between the 2 groups during the 48-h and the 44-h periods and during the 2 daytime and nighttime periods respectively. Results: During 48-h or 44-h periods and daytime or nighttime, brachial SBP/DBP and aortic SBP/DBP were significantly higher in cases than in controls. All brachial SBP/DBP BPV indexes [SD, weighted SD (wSD), coefficient-of-variation (CV) and average-real-variability (ARV)] were not significantly different between groups during the 48- or 44-h periods (48-h: SBP-ARV 11.59 ± 3.05 vs. 11.70 ± 2.68, p = 0.844, DBP-ARV: 8.60 ± 1.90 vs. 8.90 ± 1.63, p = 0.357). Analysis stratified by day or night between days 1 and 2 revealed, in general, similar results. No significant differences in dipping pattern were observed between groups. Analysis of aortic BPV had similar findings. Conclusions: BPV is similar between those with and without intradialytic hypertension. However, those with intradialytic hypertension have a sustained increase in systolic and diastolic BP during the entire interdialytic interval.

Blood pressure and volume management in dialysis: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference

“…33,34 Intradialytic hypertension has an estimated prevalence of 5%-15%, depending on the definition used ( Table 2). Defining it as an SBP increase of >10 mm Hg from pre-to post-dialysis accurately identifies persons with persistently elevated interdialytic BP 35 and demonstrates an association with hospitalization and mortality. 36,37 An SBP increase of >10 mm Hg from pre-to post-dialysis into the hypertensive range in at least 4 of 6 consecutive dialysis treatments should prompt a more extensive evaluation of BP and volume management, including out-of-unit BP measurements and a critical assessment of dry weight.…”

Barriers and facilitators to exercise in haemodialysis patients: A systematic review of qualitative studies

“…Dialysis is the most widely available form of maintaining life for patients with ESRD, and it is estimated to be needed by more than two million people worldwide (Magnard et al, 2013). The complications resulted by ESRD or haemodialysis still exist, such as renal hypertension (Bikos et al, 2018), reduced aerobic capacity and walking capacity (Cho et al, 2018). Recent studies show that exercise training has a lot of potential benefits.…”

The optimal exercise modality and intensity for hemodialysis patients incorporating Bayesian network meta-analysis and systematic review

“…Future trials could assess the effect of exercise on the clearance of middle molecules and protein-bound uremic toxins. The prevalence of hypertension among HD patients was up to 70-90% (Bikos et al, 2018), and uncontrolled hypertension was strongly associated with cardiovascular diseases (Loutradis et al, 2017). Our result found that exercise modalities did not affect blood pressure control, similar to a recent meta-analysis (Huang et al, 2019), which showed that the effect size of exercise on SBP and DBP was −0.18 (−0.42, 0.07) and −0.23 (−0.69, 0.24), respectively.…”