Intradialytic hypertension during chronic haemodialysis and subclinical fluid overload assessed by bioimpedance spectroscopy

Sebastian, Sajith; Filmalter, Christelle; Harvey, Justin; Chothia, Mogamat-Yazied

doi:10.1093/ckj/sfw052

Cited by 29 publications

(30 citation statements)

References 27 publications

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“…The frequency of DHBP in our series was 40.5%. This frequency is close to that found in a study conducted in Cameroon [5] which reported a frequency of 48.3%, in Nigeria 45.3%, and in the Philippines 37% [11], but far higher than that found in the United States in 2018 with 5% -20% of treatments hemodialysis [6]; Italy in 2016 with 23.1% [12]; South Africa 28.4% [13]. In Senegal, it was 22.6% [7].…”

Section: Discussionsupporting

confidence: 83%

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

Diakité¹,

Baldé²,

Koné³

et al. 2020

OJNeph

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Introduction: Dialytic high blood pressure (DHBP), although often ignored, is now recognized as a recurring and persistent phenomenon in a subgroup of hemodialysized patients. Its occurrence is associated with an increased risk of hospitalization and death. The objective of the study was to determine the prevalence of intradialytic hypertension and the factors associated with it. Methods: Study was cross-sectional, monocentric, descriptive and analytical over a three-month period from April 22 to July 22, 2019. Included were all patients 18 years of age or older, chronic hemodialysis for at least three months, with intra-dialytic high blood pressure. The blood pressure machine used for the majority of patients was an electronic "OMRON" blood pressure monitor. Epidemiological, clinical, para clinical and dialysis parameters were studied. The data were collected, captured and analyzed using IBM SPSS Statistics Version 20 software. The factors associated with intradialytic high blood pressure were searched using a univariate logistic regression model. The significance threshold for all statistical tests has been set at 5%. Results: Of our 131 patients, 53 had intradialytic hypertension, a frequency of 40.5%. The time of (DHBP) occurrence was more frequent at the 3rd and 2nd hour, 94.34% and 86.79%, respectively. The average age of patients was 45.51 years with extremes ranging from 19 to 70 years. The average Systolic Blood Pressure (SBP) before dialysis was 148 mm Hg −16.62 and the average Diastolic Blood Pressure (DBP) before dialysis was 88 mm Hg −12.50. Pre-dialysis Blood Pressure-140/90 mm Hg was noted in 18 cases, or 34.0%. The intradialytic average SBP was 164 mm Hg −17.25 with extremes of 121 to 202 mm Hg. The intradialytic average DBP was 92 mm Hg −12.

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Section: Discussionsupporting

confidence: 83%

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

Diakité¹,

Baldé²,

Koné³

et al. 2020

OJNeph

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“…However, our study includes objective measurements of ECV using the BIS equipment to establish this relationship along a more continuous spectrum of volume states. Our findings also significantly expand on 3 recent case-control studies, which showed that patients with intradialytic BP increases had more volume overload based on BIS measurements than those with intradialytic BP decreases [7, 8, 26]. However, our study establishes that the repeated measurements included in the IBPS provide superior information than just the change in systolic BP from pre- to post-HD and that one can predict the relative degree of ECV overload based on the IBPS.…”

Section: Discussionsupporting

confidence: 81%

Assessing Extracellular Volume in Hemodialysis Patients Using Intradialytic Blood Pressure Slopes

Líu

Lü

Shastri

et al. 2018

Nephron

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Background/Aims: Extracellular volume (ECV) overload is a mortality risk factor in hemodialysis patients, but no standard approach exists to objectively assess this clinically. We aimed to quantify relationships between slopes of repeated intradialytic blood pressure (BP) measurements and ECV. Methods: In a cross-sectional study of 71 hemodialysis patients, we calculated BP slopes from all intradialytic measurements using Gaussian regression. We measured extracellular and total body water (TBW) with bioimpedance spectroscopy. We analyzed unconditional and conditional associations between BP slope and volume metrics with mixed linear models and sensitivity analyses using non-linear intradialytic BP trajectory. Results: Mean systolic intradialytic BP slope (IBPS) was –0.06 (0.1) mm Hg/min. Post-dialysis extracellular water (ECW)/weight was the volume metric mostly strongly associated with slope (r = 0.34, p = 0.007 for unconditional analysis; β = 1.45, p = 0.001 for conditional analysis). Among subjects with post-dialysis systolic BP ≥130 mm Hg, the association strengthened (r = 0.40, p = 0.006; β = 1.42, p = 0.003). ECV was more strongly associated with the BP slope than with pre-dialysis, post-dialysis, or delta systolic BP (r = –0.07, 0.19, 0.28; p = 0.6, 0.1, 0.03). In nonlinear models, BP trajectory also had the strongest association with post-dialysis ECW/body weight (p < 0.001). Conclusions: In hypertensive hemodialysis patients, measurements of ECV excess are more strongly associated with IBPSs than with pre-dialysis, post-dialysis, or change in systolic BP. Among varying volume metrics, post-dialysis ECW/weight has the strongest association with these slopes. Determining IBPS is a novel method to optimize clinical assessment of ECV in hemodialysis patients.

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“…This prevalence was comparable to that reported by Attilio [11] in Italy, which was 23.1%. However, it was lower than that of Sinomono [10] in Morocco, Sebastian [16] in South Africa and Mackanga [17] in Gabon, which reported prevalence rates of 29.17%, 28.4%, and 28.99% respectively. It was higher than that of the CLIMB study [18] as well asthe WAVE 2 study [19], which reported respective prevalence rates of 13.2% and 12%.…”

Section: Discussionmentioning

confidence: 67%

Intradialytic Hypertension: Prevalence and Associated Factors in Chronic Hemodialysis Patients in Senegal

Faye¹,

Lemrabott²,

Kane³

et al. 2018

OJNeph

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Introduction: Intradialytic hypertension is defined as elevation of blood pressure to more than 10 mmHg in the post-dialysis period as compared to the pre-dialysis one. It is an important factor of morbidity and mortality in hemodialysis patients. The aim of our study is to assess the prevalence and associated factors of intradialytic hypertension. Patients and methods: This is a descriptive and analytical cross-sectional study that was conducted over a period of 3 weeks in the hemodialysis units of Aristide Le Dantec Hospital in Dakar and Regional Hospital Center in Ziguinchor. Chronic hemodialysis patients who are at least 18 years old and agreed to participate in study have been included. Patients who did not have 4 measures or those who decided to withdraw from the study were excluded. Intradialytic hypertension was restrained by an increase in systolic blood pressure immediately after the hemodialysis session > 10 mmHg compared to that recorded before session, with a repetition of this phenomenon for at least 4 hemodialysis sessions. Results: Our study included 539 hemodialysis sessions for 93 hemodialysis patients with a mean age of 48.72 ± 14.06 years and a sex ratio (M/F) of 1.21. The mean duration of dialysis was 64.22 ± 45.63 months. Hypertensive nephropathy was significantly common, noted in 38.7% (36 patients). Mean inter dialytic weight gain was 2.04 ± 1.06 kg, and the average dry weight was 62.71 ± 13.69 kg. The average hemoglobin level was 9.27 ± 1.91 g/dl. The mean albumin level was 35.4 ± 7.48 g/l. Nineteen (19) patients were administered erythropoietin stimulating agents (20.4%), and 59 patients were given antihypertensive drugs (63.4%). An elevation of more than 10 mmHg of post-dialysis BP compared to pre-dialysis was noted in 179 sessions, which is 33.2 per 100 How to cite this paper: Moustapha, F., Tall30 Open Journal of Nephrology hemodialysis sessions. IDH was noted in 21 patients, which represents 22.6%. The factors associated with IDH were as follows: high post-dialysis pulse pressure (PP) (p = 0.0008), pre-dialysis systolic-diastolic hypertension (p = 0.004), pre-dialysis pure systolic hypertension (p = 0.01), post-dialysis hypertension (p = 0.02), and hypoalbuminemia (p = 0.049). Conclusion: Although recognized for many years, the intradialytic hypertension is often neglected. However, it is common in our cohort of chronic hemodialysis with several associated factors. Its management is essential and will necessarily pass through adequate management of the blood volume.

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Intradialytic hypertension during chronic haemodialysis and subclinical fluid overload assessed by bioimpedance spectroscopy

Cited by 29 publications

References 27 publications

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

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

Assessing Extracellular Volume in Hemodialysis Patients Using Intradialytic Blood Pressure Slopes

Intradialytic Hypertension: Prevalence and Associated Factors in Chronic Hemodialysis Patients in Senegal

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