Blood Pressure Control and Symptomatic Intradialytic Hypotension in Diabetic Haemodialysis Patients: A Cross-Sectional Survey

Abstract

Background:Cardiovascular disease remains the most common cause of mortality in end-stage kidney failure patients with diabetes. To improve blood pressure control, and reduce cardiovascular risk, in 2002 the UK Renal Association Standards’ Committee introduced pre- and post-dialysis target blood pressures of <140/90 and <130/80 mm Hg, respectively. Methods: We audited blood pressure control and symptomatic intradialytic hypotension during 1 week in the eleven renal centres in the Greater London Urban Area in 2,193 patients, capturing 6,579 haemodialysis sessions. Results: Although 73.9% of the 658 diabetic patients were prescribed antihypertensive medications, compared to 57.8% of the 1,535 non-diabetic patients (p < 0.001), both the mean pre- and post-dialysis blood pressures were greater in the diabetic patients: before dialysis 152 ± 23/77 ± 13 versus 144 ± 23/79 ± 13 mm Hg and after dialysis 138 ± 24/71 ± 12 versus 132 ± 26/73 ± 13 mm Hg, and fewer diabetic patients achieved the pre- and post-dialysis blood pressure targets: 28.6 versus 40.8% and 37.9 versus 46.3%, respectively (p < 0.01). In addition, more diabetic patients suffered symptomatic intradialytic hypotension, 20.3 versus 14.9% (p < 0.01), associated with greater interdialytic weight gains. Conclusion: Diabetic haemodialysis patients had higher blood pressures, both before and after dialysis, associated with greater interdialytic weight gains and more frequent symptomatic intradialytic hypotension.

Does Diabetes Mellitus Predispose to Increased Fluid Overload in Peritoneal Dialysis Patients?

“…Diabetic patients have increased thirst [7], and a recent multi-centre study showed that diabetic haemodialysis patients were more likely to have greater inter-dialytic weight gain than nondiabetics [8], which is in keeping with an earlier report showing that diabetic control was linked to inter-dialytic weight gain [9]. Multi-frequency bioimpedance has been validated as an objective measure of fluid and nutritional status in dialysis patients.…”

“…Previous studies in haemodialysis patients have reported that diabetic dialysis patients have greater inter-dialytic weight gain [8], and that those patients with poor diabetic control, as assessed by HbA1c, had greater inter-dialytic weight gain [18]. This may be due to the fact that diabetic patients with poor diabetic control and high HbA1c values may have increased thirst [7].…”

The Effect of Serum Sodium on Survival in Patients Treated by Peritoneal Dialysis in the United Kingdom

“…There has been debate as to the effect of increasing glucose concentrations on the measurement of serum sodium using indirect potentiometer and flame photometry [14], and potential correction factors for adjusting serum sodium for glucose, with some studies reporting no difference in serum sodium concentration between diabetic and non-diabetic dialysis patients [6,15]. Previous observational studies have suggested greater inter-dialytic weight gains in diabetic patients [16], and greater ratio of extracellular to total body water in diabetic peritoneal dialysis patients [17], suggesting that hyponatraemia in diabetic dialysis patients may have an over hydration component, perhaps due to increased thirst. However, when we repeated our analyses after excluding those patients who had diabetes as the primary cause of end-stage kidney disease, the association between lower serum sodium and mortality remained, as did the effect of age.…”

Interdialytic Weight Gain in Diabetic Haemodialysis Patients and Diabetic Control as Assessed by Glycated Haemoglobin

“…Due to the higher weight gains, intradialytic hypotension was increased in the diabetic patients [9]. As there may be potential confounding factors in multi-centre studies, such as differing dietetic and educational input and dialysate sodium concentrations, we decided to prospectively audit interdialytic weight gains in a single centre to determine whether there was any association between diabetic control and interdialytic weight gains.…”