Is 44-Hour Better than 24-Hour Ambulatory Blood Pressure Monitoring in Hemodialysis?

Martin, Luís Cuadrado; Franco, Roberto Jorge da Silva; Gavras, Irène; Matsubara, Beatriz Bojikian; Okoshi, Katashi; Zanati, Silméia Garcia; Júnior, João Garcia Caramori; Barretti, Pasqual; Balbi, André Luís; Gavras, Haralambos

doi:10.1159/000096176

Cited by 9 publications

(11 citation statements)

References 41 publications

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“…There seems to be a majority of dose-increases in the placebo group, which might explain the reduction in BP seen in placebo group. In hemodialysis patients BP is shown to increase in the inter-dialysis period [33]. Since BP is dependent on volume status, an improvement of volemic state might explain the reduction in BP.…”

Section: Discussionmentioning

confidence: 99%

Cardiovascular effects of cholecalciferol treatment in dialysis patients – a randomized controlled trial

et al. 2014

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BackgroundPatients on chronic dialysis are at increased risk of vitamin D deficiency. In observational studies plasma 25-hydroxyvitamin D (p-25(OH) D) levels are inversely correlated with plasma BNP and adverse cardiovascular outcomes. Whether a causal relation exists has yet to be established. The aim of this study was to test the hypothesis that cholecalciferol supplementation improves cardiac function and reduces blood pressure (BP) and pulse wave velocity (PWV) in patients on chronic dialysis.MethodsIn a randomized, placebo-controlled, double-blind study, we investigated the effect of 75 μg (3000 IU) cholecalciferol daily for 6 months, in patients on chronic dialysis. We performed two-dimensional echocardiography, with doppler and tissue-doppler imaging, 24-h ambulatory BP (24-h BP), PWV, augmentation index (AIx), central BP (cBP) and brain natriuretic peptide (BNP) measurements at baseline and after 6 months.ResultsSixty-four patients were allocated to the study. Fifty dialysis patients with a mean age of 68 years (range: 46–88) and baseline p-25(OH) D of 28 (20;53) nmol/l completed the trial. Cholecalciferol increased left ventricular (LV) volume, but had no impact on other parameters regarding LV structure or left atrial structure. LV systolic function, LV diastolic function, PWV, cBP, AIx and BNP were not changed in placebo or cholecalciferol group at follow-up. 24-h BP decreased significantly in placebo group and tended to decrease in cholecalciferol group without any difference between treatments.ConclusionSix months of cholecalciferol treatment in patients on chronic dialysis did not improve 24-h BP, arterial stiffness or cardiac function.Trial registrationNCT01312714, Registration Date: March 9, 2011.

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Section: Discussionmentioning

confidence: 99%

Cardiovascular effects of cholecalciferol treatment in dialysis patients – a randomized controlled trial

et al. 2014

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“…45 In particular, the effects of a reduced IWG on blood pressure should be examined via 24-h or 48-h blood pressure measurement in order to obtain a more exact evaluation of blood pressure characteristics 46 and to interpret possible differences in the survival rate. 47 Combined with regular medical and custodial care, TBWM is a feasible method to optimize the IWG and to reducte UFR at dialysis. Interventions by phone and instruction during dialyses can be planned easily.…”

Section: Discussionmentioning

confidence: 99%

Body Weight Telemetry Is Useful to Reduce Interdialytic Weight Gain in Patients with End-Stage Renal Failure on Hemodialysis

Neumann¹,

Wagner²,

Menne

et al. 2013

Telemedicine and e-Health

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Lacking compliance with liquid intake restrictions is one of the major problems in patients on hemodialysis and causes an increased mortality. In 120 patients on hemodialysis with an average interdialytic weight gain (IWG) exceeding 1.5 kg on at least 2 days during the 4 weeks preceding the intervention, the effect of telemetric body weight measurement (TBWM) on IWG, ultrafiltration rate, and blood pressure was evaluated over a period of 3 months. Patients of the telemetric group (TG) were supplied with automatic scales, which transferred the weight via telemetry on a daily basis. In the case of IWG of more than 0.75 kg/24 h, a telephonic contact was made as required, and in the case of an IWG of more than 1.5 kg, telephonic contacting was obligatory along with the advice of a liquid intake restriction to 0.5 L/day until the next dialysis. The patients of the control group (CG) received standard treatment without telemetric monitoring. We examined specific data of the second interdialytic interval (IDI2) and the average within 1 week. The average difference of IWG between TG and CG was not significant before the start of the study but 0.2 kg (p=0.027) (IDI2)/0.27kg (p=0.001) (WP) at the end of the study, respectively. The average difference in the ultrafiltration rate within 1 week was 19.0 mL/h (p=0.282) (IDI2)/8.2 mL/h (p=0.409) before the start of the study but 28.4 mL/h (p=0.122) (IDI2)/30.9 mL/h (p=0.004) at the end of the study, respectively. Thus, TBWM is a feasible method for optimizing the IWG and reducing the ultrafiltration rate. AbstractLacking compliance with liquid intake restrictions is one of the major problems in patients on hemodialysis and causes an increased mortality. In 120 patients on hemodialysis with an average interdialytic weight gain (IWG) exceeding 1.5 kg on at least 2 days during the 4 weeks preceding the intervention, the effect of telemetric body weight measurement (TBWM) on IWG, ultrafiltration rate, and blood pressure was evaluated over a period of 3 months. Patients of the telemetric group (TG) were supplied with automatic scales, which transferred the weight via telemetry on a daily basis. In the case of IWG of more than 0.75 kg/24 h, a telephonic contact was made as required, and in the case of an IWG of more than 1.5 kg, telephonic contacting was obligatory along with the advice of a liquid intake restriction to 0.5 L/day until the next dialysis. The patients of the control group (CG) received standard treatment without telemetric monitoring. We examined specific data of the second interdialytic interval (IDI2) and the average within 1 week. The average difference of IWG between TG and CG was not significant before the start of the study but 0.2 kg (p = 0.027) (IDI2)/0.27kg (p = 0.001) (WP) at the end of the study, respectively. The average difference in the ultrafiltration rate within 1 week was 19.0 mL/h (p = 0.282) (IDI2)/ 8.2 mL/h (p = 0.409) before the start of the study but 28.4 mL/h (p = 0.122) (IDI2)/30.9 mL/h (p = 0.004) at the end of the study, ...

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“…Martin et al. considered that HD patients should be subjected to 44‐h ABPM, and concluded that the increase in BP in the second half of the interdialytic period of 44‐h ABPM is of pathophysiological and prognostic importance regardless of the absolute mean BP value (3). In this study, no statistical significance was found for ABPM in the first 22 h, but mortality was found to be statistically significant in the second half of ABPM, as shown by the Cox hazard model (3).…”

Section: Discussionmentioning

confidence: 99%

“…The best timing and method of blood pressure (BP) measurement in HD patients are still uncertain. The BP variability and extreme changes of the volemic state make it difficult to obtain truly representative values of BP in HD patients if these are based only on isolated BP measurements in a dialysis center (3). There are many differences in terms of BP measurement techniques, the timing of measurements in relation to the HD session, and reliance on the use of home BP measurements or ambulatory blood pressure (ABP) monitoring (ABPM) (4).…”

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confidence: 99%

Blood Pressure Measurements and Carotid Intima Media Thickness in Hemodialysis Patients

Ekart¹,

Hojs

Pečovnik-Balon

et al. 2009

Ther Apher Dial

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In hemodialysis (HD) patients, routine dialysis center blood pressure (BP) measurements may be a poor indicator of BP control. Ambulatory blood pressure monitoring (ABPM) improves the predictability of BP as a risk factor for target organ damage. Carotid intima-media thickness (IMT) is an important indicator of asymptomatic atherosclerosis and a predictor of cardiovascular events. The purpose of our study was to evaluate the possible association between different BP measurements and carotid IMT in HD patients. Eighty-five HD patients were included in our study. BP was measured with a standard mercury sphygmomanometer before and after each HD session. The average one-monthly values of routine BP measurements were also analyzed. 24- and 48-h ABPM was performed after the end of each HD session using non-invasive ABPM. The average values of systolic and diastolic BP were analyzed separately for the first (HD) and second (interdialytic) days ABPM, and for both days together. Using B-mode ultrasonography, carotid IMT was measured and plaque occurrence investigated. We found a statistically significant correlation between carotid IMT and the average one-monthly pre-HD diastolic BP (P < 0.05), diastolic BP on the HD-day ABPM, the interdialytic-day ABPM, and during 48-h ABPM (P < 0.05). By multiple regression analysis, we found a statistically significant correlation only between carotid IMT and diastolic BP on the HD-day ABPM, the interdialytic-day ABPM, and during 48-h ABPM (P < 0.05). Only longer BP measurements (24- and 48-h ABPM) were associated with carotid IMT in HD patients.

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Is 44-Hour Better than 24-Hour Ambulatory Blood Pressure Monitoring in Hemodialysis?

Cited by 9 publications

References 41 publications

Cardiovascular effects of cholecalciferol treatment in dialysis patients – a randomized controlled trial

Cardiovascular effects of cholecalciferol treatment in dialysis patients – a randomized controlled trial

Body Weight Telemetry Is Useful to Reduce Interdialytic Weight Gain in Patients with End-Stage Renal Failure on Hemodialysis

Blood Pressure Measurements and Carotid Intima Media Thickness in Hemodialysis Patients

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