Blood Pressure Recordings During Hemodialysis Access Interventions: Implications for Acute Management

Abstract

A retrospective study evaluating the pattern of blood pressure and its related complications before, during, and after percutaneous hemodialysis interventions was performed in patients presenting with asymptomatic hypertension. Hemodialysis patients undergoing percutaneous interventions including tunneled hemodialysis catheter insertion, percutaneous balloon angioplasty and thrombectomy procedure, and stage II hypertension (systolic blood pressure ≥160 mmHg) were included in this analysis. Blood pressure medications were not used while midazolam and fentanyl were routinely administered. Patients were followed for up to 4 weeks to monitor any complications. The mean blood pressure before, during, and after the procedures were 185 ± 18/96 ± 14, 172 ± 22/92 ± 15, and 153 ± 25/87 ± 14, respectively. There was a statistically significant difference between the blood pressure readings before and after the procedure (before = 185 ± 18/96 ± 14, after = 153 ± 25/87 ± 14; p = 0.001). None of the patients had a stroke, myocardial infarction, or acute pulmonary edema before, during, or after the procedure or during the 4-week follow-up period. A significant reduction in blood pressure was observed after the procedure without the administration of any antihypertensive medication. These results suggest that the reduction in blood pressure observed after percutaneous dialysis access interventions (particularly in the presence of midazolam and fentanyl) may make it unnecessary to treat asymptomatic hypertension prior to these procedures.

Pneumatic Tourniquet for Surgical Procedures of Hemodialysis Vascular Access

“…Hypertension as a diagnosis is almost universally present in patients undergoing surgical procedures of hemodialysis access. The blood pressure is controlled in most of these patients and moderate hypertension typically does not require immediate intervention as the blood pressure tends to become lower in patients undergoing conscious sedation . However, a systolic blood pressure near or above 180–200 may need to be lowered with fast‐acting medications before surgery to reduce the required tourniquet inflation pressure in our opinion.…”

Management of Hypertension in Patients during Percutaneous Dialysis Access Interventions

“…The above-cited study provides evidence that dialysis patients undergoing percutaneous interventions can successfully undergo procedures despite BP in a range that could potentially make an interventionalist nervous about undertaking an intervention (1). The procedures then allow for access to be available for dialysis therapy.…”

“…At least one study has investigated patients undergoing percutaneous dialysis access interventions with a systolic BP ≥160 mmHg (1). In that study, 103 dialysis patients undergoing percutaneous interventions (tunneled hemodialysis catheter insertion and percutaneous balloon angioplasty, stent placement, and thrombectomy procedures) were included.…”