Intradialysis blood pressure changes among chronic kidney disease patients on maintenance haemodialysis in a tertiary hospital south - south Nigeria: a 2 year retrospective study

Abstract

Introduction Haemodialysis (HD) which is a form of renal replacement therapy commonly prescribed for patients with chronic kidney disease (CKD). However, it is not without deleterious haemodynamic responses which may occur either during or immediately after the termination of the procedure. These may include hypotension or hypertension. Methods This was a retrospective study that reviewed chronic kidney disease (CKD) patients on maintenance haemodialysis at the renal unit of University of Calabar Teaching Hospital, Calabar, Nigeria. In all, 71 patients were reviewed but only 64 patients had complete data for analysis. Socio-demographic, clinical and biochemical data were obtained from the records in the dialysis unit. Results There were more males 38 (59.4%) than females 26 (40.6%) in the study. The mean age was 51.71±15.43 years and 43.04±14.03years for males and females respectively. The prevalence of intradialysis hypertension 29 (45.3%) was higher than that of intradialysis hypotension 20 (31.3%) and the commonest cause of CKD requiring haemodialysis was diabetic nephropathy. The factors associated with intradialysis hypotension were lower post-dialysis systolic blood pressure (PDSBP), diastolic blood pressure (DBP), mean arterial pressure (MAP) and less number of antihypertensive medications; while the factors associated with intradialysis hypertension were higher post-dialysis systolic blood pressure (SBP), MAP, greater number of antihypertensive medications and longer duration of haemodialysis. Conclusion Our study shows that there are several modifiable factors associated with blood pressure fluctuations among CKD patients on maintenance haemodialysis in the renal unit of the University of Calabar Teaching Hospital, Calabar.

Intradialysis hypotension and hypertension in patients with end stage kidney disease in Nigeria: risk factors and clinical correlates

“…The diminished glomerular filtration (the initiating stage of urine formation) cause increased inter dialytic weight gain (from excessive fluid retention) and this is commonly managed with large volume ultrafiltration which can precipitate IDH. 27 The use of erythropoiesis stimulating agents (ESAs) increased the risk for IDHT, similar to findings by Wilson et al that linked the use of ESAs with hypertension, hyperviscousity and thrombus formation. 28 The positive correlation between BMI and IDHT in this study, mirrors findings by Shu-Zhong.…”

Intradialytic Hypertension and Associated Factors in Chronic Hemodialysis at the National Hemodidiadiasis Center in Donka, Guinea

“…Cameroon, which had found age as a factor associated with the occurrence of DHBP. Which would be at odds with those found by Okpa and Col. Nigeria [15], Labarcon and Bad-ang in the Philippines [11], and Van Buren and Col. Texas who had not found a statistically significant link. This finding could be explained in our series by the youngness of the Guinean population, but also by the shorter life expectancy of our population, which is 60.62 [16] years.…”

“…Among patients with DHBP, men were the most represented 66.0% (n-35) versus 33.9% (n-18) of women, or a sex ratio of 1.9 in favour of men (Text). This result is consistent with those found by Labarcon and Bad-ang in the Philippines [11] in 2015, Sebastian and Col. in South Africa in 2016 [13] and Okpa and Col. Nigeria in 2019 [15] who reported male predominance with a sex ratio of 1.1; 1.2 and 1.2 respectively. Our results are identical to those reported by Moustapha and collar.…”

Low-Dose Dopamine in the Management of Intradialysis Hypotension: A Retrospective Cohort Study in Nigeria

“…The frequency of symptomatic IDH falls within the very wide range reported in previous studies, but higher than the 10.1% reported by Kuipers et al 44 for the EBPG, and lower than the 31.3% found in a study in Nigeria. 6 The lower rate in the EBPG compared to this study is expected, considering the association of several limiting factors in LINs that would normally entail higher rates of dialysis complications like IDH. One would have expected a higher rate compared to findings by Okpa and his group, 6 since intradialysis hypertension was excluded in this study, but the subjective nature of symptom reportage and perhaps the acceptance of these by the dialysis team could differ widely between centres.…”

“…[3][4][5] In the authors' local environment, the prevalence of IDH is reported to be 31.3% and 19.4% using the NKF-KDOQI criteria, and 8.6% using the European Best Practices Guidelines (EBPG). [6][7][8] The absence of a consensus definition has limited the scope of research on IDH and its outcome. However, Flythe et al 10 reported that the nadir BP was more predictive of future mortality of the eight IDH definitions they reviewed.…”