Blood pressure target for the dialysis patient

McCallum, Wendy; Sarnak, Mark J.

doi:10.1111/sdi.12754

Cited by 13 publications

(22 citation statements)

References 49 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, the evidence to support these recommendations are weak as it was extrapolated from observational studies or data derived from non-ESRD patients (Chang, 2011). On the other hand, studies have reported that a high percentage of patients achieving these targeted blood pressure range suffered from intradialytic hypotension, which may lead to myocardial stunning phenomena and death (McIntyre and Goldsmith, 2015;MacEwen et al, 2017;McCallum and Sarnak, 2019).…”

Section: Introductionmentioning

confidence: 99%

Taking a Step Further in Identifying Ideal Blood Pressure Range Among Hemodialysis Patients: A Systematic Review and a Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

Background: Hypertension is one of the primary predictor of mortality among end-stage renal disease (ESRD) patients on dialysis. However, there is no consensus on an ideal blood pressure range for this population. Aims and Objective: To identify an ideal systolic blood pressure range based on optimal survival among ESRD patients on dialysis. Method: A systematic search for clinical trials assessing the impact of different systolic blood pressure range on mortality among ESRD patients on hemodialysis was conducted through PubMed, EBSCOhost, Science Direct, Google Scholar, and Scopus. All randomized control trials (RCTs) involving ESRD patients on hemodialysis with primary or secondary outcome of assessing the impact different systolic blood pressure range (< 140 and >140 mm Hg) on all-cause mortality were included. The quality of reporting of the included studies was evaluated using the Jadad scale. Two researchers independently conducted eligibility assessment. Discrepancies were resolved by discussion and consultation with a third researcher when needed. Pooled relative risks (RRs) with 95% confidence intervals (CIs) were calculated. Results: A total of 1,787 research articles were identified during the initial search, after which six RCTs met our inclusion criteria. According to the Jadad scale, all six RCTs scored 3 points each for quality of reporting. Four RCTs employed pharmacological intervention while two RCTs assessed non-pharmacological intervention. Of the six RCTs, two studies were able to achieve a systolic blood pressure of <140 mm Hg at the end of trial with a RR for reduction in mortality of 0.56 (95% CI, 0.3-1.07; P = 0.08). Four RCTs were able to achieve a systolic blood pressure of >140 mm Hg at the end of trial, with the RR for reduction of mortality of 0.72 (95% CI, 0.54-0.96; P = 0.003). Overall, pooled estimates of the six RCTs suggested the reduction in systolic blood pressure statistically reduce all cause of mortality (RR, 0.69%; 95% CI, 0.53-0.90; P = 0.006) among ESRD patients on hemodialysis. Conclusion: Though not statically significant, the current study identifies <140 mm Hg as a promising blood pressure range for optimum survival among ESRD patients on

show abstract

Section: Introductionmentioning

confidence: 99%

Taking a Step Further in Identifying Ideal Blood Pressure Range Among Hemodialysis Patients: A Systematic Review and a Meta-Analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

“…Hemodiafiltration sessions were delivered three times per week with volumetric dialysis machines (Fresenius Medical Care, model 4008H) and filters F60 and F80 (Fresenius Medical Care, Bad Homburg, Germany). Following our institution policies, hypertension was maintained and controlled by a strict prescription of dry weight, with no antihypertensive drugs (21). All patients were on an unrestricted diet and performed exercise with a stationary bicycle during dialysis sessions.…”

Section: Methodsmentioning

confidence: 99%

Dynamical interaction between heart rate and blood pressure of end-stage renal disease patients evaluated by cross recurrence plot diagonal analysis

González

Infante

Martínez-García

et al. 2020

Journal of Applied Physiology

View full text Add to dashboard Cite

The assessment of spontaneous variability of blood pressure and heart rate is based on specific physiological hypotheses about dynamic features, for example, the baroreflex modulation of heart rate over time in daily life. Usually, arterial baroreflex control of heart rate is explored without delays between blood pressure and heart rate data points, within a narrow range of values, excluding the analysis of saturation regions or low-threshold changes. In this work, we examine the dynamic interactions between systolic blood pressure (SBP) and interbeat interval (IBI), in 15-min length time series and for the first time using the analysis of diagonals derived from a cross-recurrence plots in healthy persons and end-stage renal disease (ESRD) patients. We found that ESRD patients have stronger intermittent dynamical interactions between IBI and SBP, but they lose most of the dynamical interactions. Although healthy subjects exhibit a continuously changing order of precedence between IBI and SBP at different lags, ESRD patients preserve this changing order of precedence only for lags >0 beats. NEW & NOTEWORTHY This study is the first to compare the time-variant pattern of systolic blood pressure (SBP) and interbeat interval (IBI) coupling between ESRD patients and healthy volunteers through the analysis of diagonal in cross-recurrence plots, and in the face of an orthostatic challenge. Our results demonstrated alternant interactions on the order of precedence (IBI → SBP or SBP→ IBI) at different time delays. This pattern is different in resting position and during active standing for the two groups studied, and interestingly, some association patterns are lost in ESRD patients. These patterns of alternant interactions on the order of precedence could be related to autonomic neural activities and cardiovascular synchronization at different scales both in time and space. This could reflect physiological adaptive flexibility of cardiovascular regulation. Losing some association patterns in ESRD may be the result of chronic adjustments of many physiological mechanisms (including chronic sympathetic hyperactivity), which could increase cardiovascular vulnerability to hemodynamic challenges.

show abstract

“…It has been found that where long dialysis and strict salt control is applied hypertension has lower prevalence among dialysis patients [11] [20]. Hypertension in dialysis is multifactorial but sodium and water excess appear to be the major causes [11] [12]. Most of the patients were on sodium restriction.…”

Section: Discussionmentioning

confidence: 99%

Blood Pressure Control among Adult African Chronic Kidney (CKD) Patients—How Close Are We to Target?

Akpan¹,

Ekrikpo²,

Udo³

et al. 2020

OJNeph

View full text Add to dashboard Cite

Background: Chronic kidney disease (CKD) is usually progressive, often resulting in end-stage renal disease (ESRD). The two most common causes of renal disease, hypertension and diabetes mellitus contribute greatly to the mobility and mortality associated with CKD. It has been found that lowering BP is effective in reducing cardiovascular events in patient with a moderate reduction in GFR and in those with ESRD on dialysis. The aim of this study was to assess blood pressure control among adult African CKD patients. Method: The case notes of chronic kidney patients who assess care in the renal unit of our Teaching Hospital were retrieved for the study after obtaining informed consent from the ethical unit of the hospital. To be eligible for the study, the patient, must have been attending the renal clinic and on anti-hypertensives for a minimum period of 6 months. Results: Eighty-seven CKD patients (46 males and 41 females) with a mean age of 50.9 ± 13.3 years. The proportion of patients who achieved blood pressure control was 13.79% (95% CI 7.34%-22.85%). Among the pre-dialysis patients, BP control was achieved in 13.64% compared to 14.29% among the patients on dialysis. Nineteen (21.84%) of the patients were on one blood pressure lowering agent; 26 (29.89%) on two; 33 (37.93%) on three; 7 (8.05%) on four and 2 (2.30%) on five. Conclusion: Blood pressure control among African adult CKD patients is difficult with many of them requiring more than two antihypertensive drugs.

show abstract

Blood pressure target for the dialysis patient

Cited by 13 publications

References 49 publications

Taking a Step Further in Identifying Ideal Blood Pressure Range Among Hemodialysis Patients: A Systematic Review and a Meta-Analysis

Taking a Step Further in Identifying Ideal Blood Pressure Range Among Hemodialysis Patients: A Systematic Review and a Meta-Analysis

Dynamical interaction between heart rate and blood pressure of end-stage renal disease patients evaluated by cross recurrence plot diagonal analysis

Blood Pressure Control among Adult African Chronic Kidney (CKD) Patients—How Close Are We to Target?

Contact Info

Product

Resources

About