Accuracy of Peridialytic, Intradialytic, and Scheduled Interdialytic Recordings in Detecting Elevated Ambulatory Blood Pressure in Hemodialysis Patients

Sarafidis, Pantelis; Theodorakopoulou, Marieta; Loutradis, Charalampos; Iatridi, Fotini; Alexandrou, Maria‐Eleni; Καρπέτας, Αντώνιος; Koutroumpas, Georgios; Raptis, Vasileios; Ferro, Charles J.; Papagianni, Aikaterini

doi:10.1053/j.ajkd.2021.01.022

Cited by 7 publications

(11 citation statements)

References 32 publications

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“…In the present study, the findings regarding the accuracy of peridialytic BP measurement for detecting elevated ambulatory BP in patients with IDH are similar with the observations made in the general hemodialysis population [23], as both pre-and post-dialysis BP have low sensitivity and specificity for the diagnosis of high 44-h BP. In contrast to the aforementioned preliminary studies [39,40], we found that post-dialysis BP showed no correlation in simple linear analyses and the absence of agreement with 44-h BP.…”

Section: Discussionsupporting

confidence: 88%

“…In particular, in a preliminary study in 135 hemodialysis patients in the United States (90% of which were African-American), intradialytic including pre-and post-dialysis BP was a precise, accurate, and reproducible method for diagnosing high ambulatory interdialytic BP [38]. Our aforementioned study expanded the above findings, as we observed in a larger population that both intradialytic BP and intradialytic plus pre-and post-dialysis BP metrics had good performance in diagnosing high ambulatory BP with AUCs in ROC analysis at 0.850 for SBP and around 0.870 for DBP [23]. The findings of the present study for the control group of non-IDH patients are similar with the observations made in the general hemodialysis population with regards to the accuracy of all the metrics discussed above.…”

Section: Discussionsupporting

confidence: 72%

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Peridialytic and intradialytic blood pressure metrics are not valid estimates of 44-h ambulatory blood pressure in patients with intradialytic hypertension

et al. 2022

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Purpose In contrast to peridialytic blood pressure (BP), intradialytic and home BP measurements are accurate metrics of ambulatory BP load in hemodialysis patients. This study assessed the agreement of peridialytic, intradialytic, and scheduled interdialytic recordings with 44-h BP in a distinct hemodialysis population, patients with intradialytic hypertension (IDH). Methods This study included 45 IDH patients with valid 48-h ABPM and 197 without IDH. With 44-h BP used as reference method, we tested the accuracy of the following BP metrics: Pre- and post-dialysis, mean and median intradialytic, mean intradialytic plus pre/post-dialysis, and scheduled interdialytic BP (out-of-dialysis day: mean of 8:00am/8:00 pm readings). Results In IDH patients, peridialytic and intradialytic BP metrics showed at best moderate correlations, while averaged interdialytic SBP/DBP exhibited strong correlation (r = 0.882/r = 0.855) with 44-h SBP/DBP. Bland–Altman plots showed large between-method-difference for peri- and intradialytic-BP, but only + 0.7 mmHg between-method difference and good 95% limits of agreement for averaged interdialytic SBP. The sensitivity/specificity and κ-statistic for diagnosing 44-h SBP ≥ 130 mmHg were low for pre-dialysis (72.5/40.0%, κ-statistic = 0.074) and post-dialysis (90.0/0.0%, κ-statistic = − 0.110), mean intradialytic (85.0/40.0%, κ-statistic = 0.198), median intradialytic (85.0/60.0%, κ-statistic = 0.333), and intradialytic plus pre/post-dialysis SBP (85.0/20.0%, κ-statistic = 0.043). Averaged interdialytic SBP showed high sensitivity/specificity (97.5/80.0%) and strong agreement (κ-statistic = 0.775). In ROC analyses, scheduled interdialytic SBP/DBP had the highest AUC (0.967/0.951), sensitivity (90.0/88.0%), and specificity (100.0/90.0%). Conclusion In IDH patients, only averaged scheduled interdialytic but not pre- and post-dialysis, nor intradialytic BP recordings show reasonable agreement with ABPM. Interdialytic BP recordings only could be used for hypertension diagnosis and management in these subjects.

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Section: Discussionsupporting

confidence: 88%

Section: Discussionsupporting

confidence: 72%

Peridialytic and intradialytic blood pressure metrics are not valid estimates of 44-h ambulatory blood pressure in patients with intradialytic hypertension

et al. 2022

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“…An earlier diagnostic-test study showed that when the average intradialytic BP is considered jointly with peridialytic BP recordings, there is improvement in the diagnostic accuracy of BP measurement as compared to the use of predialysis and postdialysis BP measurements alone [24]. This observation is consistent with the results of a recent study showing that the sensitivity and specificity for the diagnosis of an average 44-hour ambulatory systolic BP ≥ 130 mmHg were low for predialysis (86.5%/38.6%) and postdialysis BP (63.1%/73.3%), but better for the average intradialytic BP (77.3%/76.2%) and the combination of intradialytic plus peridialytic BP (76.6%/72.3%) [25].…”

Section: Intradialytic Bp Measurementssupporting

confidence: 91%

Hypertension in Dialysis Patients: Diagnostic Approaches and Evaluation of Epidemiology

et al. 2022

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Whereas hypertension is an established cardiovascular risk factor in the general population, the contribution of increased blood pressure (BP) to the huge burden of cardiovascular morbidity and mortality in patients receiving dialysis continues to be debated. In a large part, this controversy is attributable to particular difficulties in the accurate diagnosis of hypertension. The reverse epidemiology of hypertension in dialysis patients is based on evidence from large cohort studies showing that routine predialysis or postdialysis BP measurements exhibit a U-shaped or J-shaped association with cardiovascular or all-cause mortality. However, substantial evidence supports the notion that home or ambulatory BP measurements are superior to dialysis-unit BP recordings in diagnosing hypertension, in detecting evidence of target-organ damage and in prognosticating the all-cause death risk. In the first part of this article, we explore the accuracy of different methods of BP measurement in diagnosing hypertension among patients on dialysis. In the second part, we describe how the epidemiology of hypertension is modified when the assessment of BP is based on dialysis-unit versus home or ambulatory recordings.

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“…Standardized post-dialysis SBP ≥ 139 mmHg had a sensitivity of 95% and a speci city of 73%, whereas Standardized post-dialysis DBP ≥ 92 mmHg had a sensitivity of 90% and a speci city of 76%. Sara dis et al [10] reported an AUC of post-dialysis SBP of 0.74. Agarwal et al [11], however, reported a sensitivity of 80.40% and speci city of 72.50% for a lower post-dialysis SBP threshold (≥ 130.80 mmHg).…”

Section: Discussionmentioning

confidence: 99%

Reliability of routine and standardized in-center blood pressure measurement in chronic hemodialysis patients in Dakar: a case control study

Faye

Ouanekpone

et al. 2023

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Background Blood pressure (BP) measurement in the diagnosis and monitoring of hypertension continues to be a topic of debate. The objectives of this study were 1) to evaluate the performance of hemodialysis center BP measurements (routine and standardized BP measurements) in the diagnosis of ambulatory BP in chronic hemodialysis patients using 44h ambulatory BP monitoring (44h-ABPM) as the reference measurement; 2) to compare the performance of standardized and routine BP measurement; and 3) to evaluate the concordance between the values measured at the hemodialysis center and the BP values at 44h-ABPM. Methods In this 23-month case control study including 56 patients followed in the hemodialysis units of Aristide Le Dantec Hospital (HALD) and Idrissa Pouye General Hospital (HOGIP), BP was measured by 3 methods: i) an automated measurement (OMRON®) carried out by health professional called routine BP measurement (RBPM) in pre and post dialysis; ii) the mean of five automated measurements in a patient isolated in a quiet room called standardized BP measurement (SBPM) before and after dialysis; iii) 44h-ABPM with the CONTEC® device. The hypertension was defined as BP ≥ 130/80 mmHg at 44h-ABPM. Results Fifty-six (56) patients including 31 men (55%) with a mean age of 45.20 ± 13.64 years were included. Thirty-one patients (55%) were hypertensive at the 44h-ABPM. Pre-dialysis SBPM was significantly better than pre-dialysis RBPM (AUC [IC 95%], 0.881 [0.778-0.984]/0.785 [0.664-0.907], p=0.02) in detecting 44h ambulatory systolic BP (SBP) ≥ 130 mmHg. Post-dialysis SBPM was also outperformed post-dialysis RBPM (0.916 [0.843-0.988]/0.874 [0.782-0.965]) in detecting 44h ambulatory SBP ≥ 130 mmHg without statistically significant difference. Pre-dialysis SBPM outperformed pre-dialysis RBPM (0.882 [0.776-0.988]/0.878 [0.781-0.975] in detecting 44h ambulatory DBP ≥ 80 mmHg without statistically significant difference. Post-dialysis SBPM also outperformed post-dialysis RBPM (0.914 [0.832-0.996]/0.848 [0.743-0.952]) in detecting 44h ambulatory DBP ≥ 80 mmHg without statistically significant difference. Hemodialysis center measurements overestimate ambulatory BP at 44h-ABPM. Conclusion Hemodialysis center measurements overestimate ambulatory BP despite excellent performance on ROC curve analysis. SBPM performs better than RBPM and in particular in the detection of a SBP ≥ 130 mmHg in the ambulatory setting. SBPM overestimates SBP less than RBPM.

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Accuracy of Peridialytic, Intradialytic, and Scheduled Interdialytic Recordings in Detecting Elevated Ambulatory Blood Pressure in Hemodialysis Patients

Cited by 7 publications

References 32 publications

Peridialytic and intradialytic blood pressure metrics are not valid estimates of 44-h ambulatory blood pressure in patients with intradialytic hypertension

Peridialytic and intradialytic blood pressure metrics are not valid estimates of 44-h ambulatory blood pressure in patients with intradialytic hypertension

Hypertension in Dialysis Patients: Diagnostic Approaches and Evaluation of Epidemiology

Reliability of routine and standardized in-center blood pressure measurement in chronic hemodialysis patients in Dakar: a case control study

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