Home Blood Pressures Are of Greater Prognostic Value than Hemodialysis Unit Recordings

Alborzi, Pooneh; Patel, Nina; Agarwal, Rajiv

doi:10.2215/cjn.02250507

Cited by 224 publications

(215 citation statements)

References 28 publications

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“…We used ambulatory BP as a reference standard because ambulatory BP recording is an accurate estimate of the arterial pressure and shares a stronger relationship with all-cause mortality compared with BPs obtained in the dialysis unit (25). Not only can ambulatory BP provide a better mean estimate of arterial pressure over the interdialytic period, recent studies using ambulatory BP monitoring have disclosed that systolic BP increases by approximately 1 mmHg every 4 hours, and diastolic BP increases by 1 mmHg every 8 hours (26).…”

Section: Discussionmentioning

confidence: 99%

Median Intradialytic Blood Pressure Can Track Changes Evoked by Probing Dry-Weight

Agarwal

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2010

Clinical Journal of the American Society of Nephrology

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Background: Median BP obtained over a single dialysis treatment can diagnose hypertension among hemodialysis patients. Whether median BP is as useful to track change in BP is unknown.Design, setting, participants, & measurements: Among patients participating in the dry-weight reduction in hypertensive hemodialysis patients (DRIP) trial, interdialytic ambulatory BP was recorded at baseline, 4 weeks, and 8 weeks. The mean interdialytic ambulatory BP was compared to the following recordings: predialysis on one dialysis treatment (Pre1), predialysis averaged over 2 weeks of dialysis treatment (Pre6), postdialysis on one dialysis treatment (Post1), postdialysis averaged over 2 weeks of dialysis treatment (Post6), and median intradialytic BP over one treatment.Results: Pre1 was unable to detect change in ambulatory BP. Although Pre6 was able to detect change, it overestimated the ambulatory BP. On average, the magnitude of reduction in Post1 in response to probing dry-weight was nearly twice that obtained by ambulatory BP monitoring. Even Post6 overestimated the magnitude of reduction in BP at 8 weeks. Median systolic BP was responsive to probing dry-weight and neither overestimated nor underestimated the interdialytic ambulatory systolic BP at baseline or over time. However, the SD of the differences between median systolic BP and interdialytic ambulatory systolic BP varied from 16 to 20 mmHg.Conclusions: Median intradialytic BP recordings can detect change in ambulatory BP evoked by reduction in dry-weight at the population level. Because of wide agreement limits between intradialytic and interdialytic BP, the individual prediction of ambulatory BP from median intradialytic BP can be misleading.

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Section: Discussionmentioning

confidence: 99%

Median Intradialytic Blood Pressure Can Track Changes Evoked by Probing Dry-Weight

Agarwal

Light²

2010

Clinical Journal of the American Society of Nephrology

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“…Mitra et al measured BP in hemodialysis patients at arrival to the dialysis unit, after 10 min of rest in a quiet room, and at other time points in relationship to dialysis (17). The authors reported that the BP on arrival to the hemodialysis unit (19). BP increases over the interdialytic period most likely because of accumulation of volume and uremic toxins (20 -23).…”

Section: Discussionmentioning

confidence: 99%

“…However, it would be premature to discontinue home BP monitoring; home BP is associated with left ventricular hypertrophy (26) and mortality in hemodialysis patients (19), relationships that are yet to established for intradialytic BP recordings. Nonetheless, BP measurements obtained during dialysis appear to contain a larger amount of diagnostic information than what is apparent in predialysis and postdialysis BP measurements alone.…”

Section: Discussionmentioning

confidence: 99%

Diagnosing Hypertension by Intradialytic Blood Pressure Recordings

Agarwal

Metiku

Tegegne

et al. 2008

Clinical Journal of the American Society of Nephrology

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“…In dialysis patients, home BP carries better prognostic impact when compared to recordings in the dialysis unit. Systolic home BP of 115-145 mmHg is associated with the best prognosis in HD patients [86]. Renin-Angiotensin-system (RAS) blockers stimulate Klotho gene expression in CKD patients.…”

Section: Management Of Traditional Risk Factorsmentioning

confidence: 99%

Arterial Calcification in Chronic Kidney Disease: Whom? When? and How to Handle?

2016

J Urol Nephrol

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Chronic kidney disease (CKD) patients have the highest mortality rate compared to other chronic diseases. Cardiovascular events account for up to 60% of the mortalities, with cardiovascular calcifications affecting the majority of those CKD patients. Most of this calcification is related to disturbed renal phosphate handling. Fibroblast growth factor 23 (FGF23) and Klotho were incriminated in the pathogenesis of vascular calcification (VC) through different mechanisms including their effect on endothelium and arterial wall smooth muscle cells. In addition, deficient Klotho gene expression is a constant feature in CKD patients. This deficiency, not only promotes vascular pathology, but also has a role in the progression of the CKD. This review will cover the medical history, prevalence, pathogenesis, clinical relevance, diagnostic tools, the ideal timing to prevent or to withhold the progression of VC and the different medications and medical procedures that can help to prolong the survival of CKD patients. IntroductionThe problematic increase of cardiovascular morbidity and mortality is behind the increased interest in VC among CKD patients. VC is a strong predictor of increased cardiovascular mortality among CKD patients. However, almost all of the clinical studies that have tried to manipulate the various risk factors for VC in dialysis patients have failed to show a significant impact on patient survival. On the other hand, when pre-dialysis patients underwent similar studies, there was a significant decrease in cardiovascular and overall mortality rates, as well as a comparable effect on VC progress rate. These results point toward the importance of early intervention. The ideal timing and dynamics of this intervention will be thoroughly discussed. VC In CKD PatientsThe prevalence of VC among pre-dialysis CKD G3-5 patients is 79% as reported in a recent study [1]. It might approach 100% in patients starting dialysis [2]. Upto 3-4 fold increase in VC has been reported in the earliest phases of CKD [3].VC in CKD can affect the tunica intima and/or the tunica media layers. Intimal calcification is mainly a feature of atherosclerosis [4]. Medial calcification is restricted to CKD and is encountered even at young ages [5,6]. Hemodialysis (HD) patients have higher calcification scores than both peritoneal dialysis (PD) and CKD G4 patients. More heavily calcified patients were significantly older and mostly male [7]. In HD patients, coronary calcification progresses steadily [8]. High serum phosphate concentration was a strong independent risk factor only in non-diabetic patients. Diabetic patients lack similar associations [9]. Patients starting dialysis at the age of 25-29 years have an expected survival 33 years less than the general populous. Arterial calcification is one of the predictors of this increased cardiovascular mortality [10].The prevalence of coronary artery calcification (CAC) in kidney transplant recipients (KTRs) is higher (61-75%) than that assessed in CKD G3, [11,12] and lower than tha...

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Home Blood Pressures Are of Greater Prognostic Value than Hemodialysis Unit Recordings

Cited by 224 publications

References 28 publications

Median Intradialytic Blood Pressure Can Track Changes Evoked by Probing Dry-Weight

Median Intradialytic Blood Pressure Can Track Changes Evoked by Probing Dry-Weight

Diagnosing Hypertension by Intradialytic Blood Pressure Recordings

Arterial Calcification in Chronic Kidney Disease: Whom? When? and How to Handle?

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