Frequency of Intradialytic Hypertension Using Kidney Disease: Improving Global Outcomes (KDIGO) Suggested Definition in a Single Hemodialysis Centre in Pakistan

Abstract

Objectives: To estimate the frequency of intradialytic hypertension (IDH) in our centre as per the definition suggested by Kidney Disease: Improving Global Outcomes (KDIGO).Methods: A cross-sectional study was conducted at the dialysis department of The Kidney Centre Post Graduate Training Institute (PGTI) Karachi, Pakistan from August 2021 to October 2021 among 263 endstage kidney disease (ESKD) patients on maintenance hemodialysis (MHD) aged ≥ 18 years of both genders. The study outcome was the frequency of IDH as per the latest KDIGO suggested definition i.e., systolic blood pressure (SBP) rise of > 10 mm Hg from pre-to post-dialysis within the hypertensive range in at least four out of six consecutive dialysis treatments. Frequencies (%) and mean (±SD) were calculated for categorical and continuous variables respectively, using SPSS version 21 (IBM Corp., Armonk, NY, USA).Results: Among 263 patients, the mean age was 51.02 (±14.1) years and 56.3% were males. Around 30.8% of patients were dialysis-dependent for 1.1 to three years. The most common comorbidity was hypertension (88.6%). Standard dialysate calcium of 3mEq/l was received by 91.6% of study participants. About 78.7% of patients were using antihypertensive(s), out of which 85.5% were compliant and 37.6% were using a single antihypertensive. The most common antihypertensive in use was beta-blockers (78.3%). Around 16% of patients were found to have IDH. Age of the patients was significantly associated with IDH (p=0.038). The majority of the patients with IDH were those who were taking anti-hypertension medications as compared to the patients who were not taking them (p <0.004). Interdialytic weight gain was not a significant predictor for IDH. Conclusion:The frequency of IDH was 16% according to the latest suggested KDIGO definition. This is much lower than regional and global estimates according to earlier definitions. There is a dire need to establish a standardized definition of IDH in guidelines to diagnose, manage and compare data. Also, the association of IDH with fluid overload is not found in our study which emphasizes the need to evaluate other causative factors.

Association of intradialytic hypertension and antihypertensive medication use in patients undergoing maintenance hemodialysis: a prospective observational study

“…These medications promote diuresis and help maintain fluid balance and hemodynamic stability in this vulnerable population. 14,18,19 The low utilization of ACE inhibitors in this study may be attributed to individual patient characteristics, contraindications, or specific preferences of healthcare providers. Similarly, thiazide diuretics are often used as add-on therapy to manage hypertension in CKD patients.…”

Epidemiology, Pathophysiology, and Clinical Perspectives of Intradialytic Hypertension

“…IDHYPER represents a frequent finding among patients on regular HD, with several research efforts being conducted in this field, as shown in Table 1. According to a recent study conducted in a single HD center in Pakistan, the prevalence of IDHYPER was 16% using the KDIGO IDHYPER definition, and this finding was more common in the elderly and those on antihypertensive medication [20]. A lower rate of IDHYPER (5% of sessions) was found in a cohort of HD patients in Eritrea [21].…”