Reproducibility of ambulatory blood pressure monitoring in hemodialysis patients

Controlling blood pressure in hemodialysis patients is crucial but not always easy. The most common blood pressure measurement method is peri-dialysis measurement, but due to interdialytic blood pressure fluctuations, we are unsure if it is the proper way for evaluating blood pressure. Some studies have shown the superiority of 24-h ambulatory blood pressure monitoring over peri-dialysis blood pressure measurement. We aimed to compare the consistency of these methods in determining hypertension among hemodialysis patients. We studied 50 patients (mean age: 55.8 years) on regular hemodialysis in Imam Khomeini University Hospital, Tehran, Iran. Peri-dialysis blood pressure and interdialytic 24-h ambulatory blood pressure monitoring were recorded for each patient. Patients' demographic data and peri-dialysis weight were recorded too. All data were analyzed using the PASW Statistics 18.0, SPSS Inc. (Chicago, IL). There was a significant difference between pre-dialysis mean systolic blood pressure (146.1 ± 23.3 mmHg) and mean systolic blood pressure recorded by ambulatory blood pressure monitoring (135.3 ± 19.3 mmHg) (p ¼ 0.001). There was also a significant difference between pre-dialysis mean diastolic blood pressure (83 ± 14 mmHg) and mean diastolic blood pressure recorded by ambulatory blood pressure monitoring (77.3 ± 10 mmHg) (p ¼ 0.003). But the frequencies of hypertension measured with both methods were significantly consistent and the Kappa agreement coefficient was 0.525 (p ¼ 0.001). Considering ambulatory blood pressure monitoring as the gold standard for blood pressure measurement, our recommendation for the best cutoff point to diagnose hypertension, with the highest sensitivity and specificity would be 135/80 mmHg for pre-dialysis blood pressure and 115/70 mmHg for post-dialysis blood pressure. KeywordsAmbulatory blood pressure monitoring, hemodialysis, hypertension, peri-dialysis blood pressure History

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“…8,11,27,28 In our study, 24% of the patients were dipper and 76% non-dipper, which agree with other studies.…”

Section: Discussionsupporting

confidence: 93%

Comparing the frequency of hypertension determined by peri-dialysis measurement and ABPM in hemodialysis patients

et al. 2014

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“…Whether this elevation is due to a white coat effect or evoked by a true increase in BP as a result of volume expansion or uremic toxin accumulation is unclear. Another study reported poor reproducibility of predialysis and postdialysis BP recordings compared with ambulatory BP (24). Thus, BP recordings measured just before or after dialysis appear to be inadequate surrogates for interdialytic ambulatory BP.…”

Section: Discussionmentioning

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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“…Rahman et al (44) suggested that standardizing the technique of BP measurement is associated with statistically lower pre-and posthemodialysis BP. More than half of the SBP and one third of the DBP were erroneous by Ͼ10 mmHg when comparing usual with the standardized technique.…”

Section: Discussionmentioning

confidence: 99%

“…ABP recording provides the most reproducible way to assess BP in dialysis patients and provides information on the day-night change in BP that may be of prognostic significance (43)(44)(45)(46). Studies now are needed to compare standardized measurement technique (39), self-recorded BP (47), and BP recorded at other time points, such as 20 min after dialysis (28), to predict ABP.…”

Section: Discussionmentioning

confidence: 99%

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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211

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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Reproducibility of ambulatory blood pressure monitoring in hemodialysis patients

Cited by 88 publications

References 48 publications

Comparing the frequency of hypertension determined by peri-dialysis measurement and ABPM in hemodialysis patients

Comparing the frequency of hypertension determined by peri-dialysis measurement and ABPM in hemodialysis patients

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

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

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