Prediction of hypertension in chronic hemodialysis patients

Agarwal, Rajiv; Lewis, Rebecca

doi:10.1046/j.1523-1755.2001.00997.x

Cited by 100 publications

(80 citation statements)

References 22 publications

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“…coefficients for agreement between 44-h interdialytic ABP and pre/postdialysis BP ranged from 0.32 to 0.60, indicating fair to moderate agreement (30). Similarly, Agarwal and Lewis (29) reported that a 2-wk averaged predialysis BP of Ͼ150/85 mmHg or a postdialysis BP of Ͼ130/75 mmHg had at least 80% sensitivity in diagnosing hypertension but had poor specificity. The combined analyses (Bland-Altman plots) clearly show that the agreement between pre/postdialysis BP and ABPM is poor.…”

Section: Discussionmentioning

confidence: 95%

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Pre- and Postdialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure

Agarwal

Peixoto

Santos

et al. 2006

Clinical Journal of the American Society of Nephrology

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213

154

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H ypertension is perhaps one of the most pervasive problems of patients with ESRD. Although current guidelines that focus on cardiovascular disease in dialysis patients call for hypertension control as a top priority, the vast majority of patients who are on hemodialysis are hypertensive and control rates are poor (1). For practical reasons, BP assessment and antihypertensive treatment in patients with ESRD is performed on the basis of measurements that are made either immediately before or after dialysis. Such timehonored practice is widely accepted and formally recommended by clinical guidelines. The recent National Kidney Foundation Kidney Disease Outcomes Quality Initiative guidelines suggest that predialysis and postdialysis BP should be Ͻ140/90 and Ͻ130/80 mmHg, respectively (2).Population-based studies, including the recent Pressioni Arteriose Monitorate e Loro Associazioni (PAMELA) (3) and Ohasama studies (4) and studies on patients who had hypertension and were referred to a specialist clinic in the Dublin Outcome Study (5), have demonstrated clearly that ambulatory BP monitoring (ABPM) provides more accurate prognostic information than office BP, an issue that seems to be of particular relevance in the elderly. In a recent analysis of the ABPM substudy of the Systolic Hypertension in Europe (Syst-Eur) trial (6), ABPM and clinic BP did not identify the same patients for antihypertensive treatment, and ABPM was a better predictor of cardiovascular outcomes than clinic BP. These considerations are of relevance to patients with ESRD because uremia is a strong catalyst of the aging process and because patients with ESRD are older, with an average age of 60 yr.Given that the population with ESRD is elderly and the relationship between ABPM and cardiovascular outcomes and total mortality has scarcely been studied, we examined the magnitude of the difference between ABPM and pre/postdialysis BP. We hypothesized that if there were substantial differences, especially when differences between the two methods of measurements were unpredictable, then the two methods of measurement may have differing prognostic significance. The primary objective of this systematic analysis was to determine the magnitude of the difference and the variability in the difference between BP that is recorded in the dialysis environment, before and after the dialysis procedure, and ABPM that is performed simultaneously in the hemodialysis population. Materials and MethodsPublished studies that had reported paired ABP and pre/postdialysis BP in patients who were undergoing conventional three times a Published online ahead of print. Publication date available at www.cjasn.org.

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Section: Discussionmentioning

confidence: 95%

“…We believe that self-recorded BP (home) monitoring is a promising technique that, via involvement of patients in the delivery of their health care, may improve BP management. Although we could not pool the results of various studies by meta-analysis, it seems that dialysis unit BP still may be useful in a qualitative sense (29). …”

Section: Discussionmentioning

confidence: 97%

Pre- and Postdialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure

Agarwal

Peixoto

Santos

et al. 2006

Clinical Journal of the American Society of Nephrology

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213

154

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“…However, most investigators have taken 2-week averaged predialysis or postdialysis BP measurements when they have compared these to ambulatory recordings (15,16). What remains unknown is the diagnostic performance of BP recording obtained just before or just after dialysis on a single occasion.…”

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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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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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“…Consequently, diagnosis and treatment of BP in PCHD must be considered in respect of pre/postdialysis MAP and especially PP values, not just depending on pre/postdialysis systolic and diastolic pressure values. 36,37 Furthermore, epidemiological studies of mortality and morbidity of PCHD must be consequently revised. Differences in MAPs and PPs could be helpful in the explanation of the 'paradox' of increasing mortality in PCHD with lower BP levels.…”

Section: Discussionmentioning

confidence: 99%

Mean arterial pressure and pulse pressure are associated with different clinical parameters in chronic haemodialysis patients

Roguljic¹,

Kovačić²,

Bačić

et al. 2003

J Hum Hypertens

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The mean arterial pressure (MAP) usually serves as an expression of blood pressure in patients on chronic haemodialysis (PCHD), instead of using solely systolic or diastolic pressure. Pulse pressure (PP) has been recognized as an important correlate of mortality in PCHD. We conducted this study in order to demonstrate clinical and biochemical determinants and variability of predialysis and postdialysis MAP and PP values. A total of 136 single haemodialysis (HD) treatments in 23 subjects (PCHD, 11 male and 12 female patients) were processed during 15 months. MAP before HD was in negative correlation with haemoglobin (Po0.001) and body mass index (BMI) (Po0.001), and in positive correlation with weekly erythropoietin dosage (P ¼ 0.017). MAP after HD was in negative correlation with haemoglobin (Po0.001), ultrafiltration per HD (P ¼ 0.015), and BMI (P ¼ 0.001), and in positive correlation with weekly erythropoietin dosage (P ¼ 0.003). PP before HD was in negative correlation with parathyroid hormone (PTH) level (P ¼ 0.020), haemoglobin (Po0.001), ultrafiltration per HD (P ¼ 0.001), and years on the chronic HD treatment (P ¼ 0.001), and in positive correlation with weekly erythropoietin dosage (Po0.001) and age (Po0.001). PP after HD was in significant negative correlation with PTH (P ¼ 0.015), haemoglobin (P ¼ 0.005), ultrafiltration per HD (Po0.001), BMI (P ¼ 0.003), and in positive correlation with weekly erythropoietin dosage (Po0.001) and age (P ¼ 0.004). Multiple regression analyses unveiled the strongest and negative correlations between MAP before HD and BMI (b ¼ À0.37, P ¼ 0.01); MAP after HD and haemoglobin (b ¼ À0.36, P ¼ 0.01); PP after HD and ultrafiltration/body weight ratio (b ¼ À0.41, Po0.001).

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Prediction of hypertension in chronic hemodialysis patients

Abstract: HD unit BP values can be used to identify the presence or absence of hypertension, although prediction of ambulatory BPs from HD unit BP values cannot be made reliably in individual patients.

Cited by 100 publications

References 22 publications

Pre- and Postdialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure

Pre- and Postdialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure

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

Mean arterial pressure and pulse pressure are associated with different clinical parameters in chronic haemodialysis patients

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