The use of peridialysis blood pressure and intradialytic blood pressure changes in the prediction of interdialytic blood pressure in haemodialysis patients

Mendes, Roger B.; Santos, Sérgio F.; Dorigo, David; Mansoor, George A.; Crowley, Susan T.; White, William Β.; Peixoto, Aldo J.

doi:10.1097/00126097-200312000-00004

Cited by 22 publications

(16 citation statements)

References 20 publications

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“…Furthermore, evidence from prior studies is limited by utilization of case-control designs or regression models that assume a linear relationship between BP change and mortality. 15–20 These studies may have been underpowered in detecting a U-shaped association (ie, high mortality with both increases and decreases in BP). We hypothesized that both increases and decreases in BP during HD (defined as post-HD BP minus pre-HD BP) are associated with increased all-cause and cardiovascular mortality independent of pre-HD BP levels.…”

Section: Introductionmentioning

confidence: 99%

A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival

Park

Rhee

Sim

et al. 2013

Kidney International

134

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It is not clear to what extent changes in blood pressure (BP) during hemodialysis affect or predict survival. Studying comparative outcomes of BP changes during hemodialysis can have major clinical implications including the impact on management strategies in hemodialysis patients. Here we undertook a retrospective cohort study of 113,255 hemodialysis patients over a 5 year period to evaluate an association between change in BP during hemodialysis and mortality. The change in BP was defined as post- minus pre-hemodialysis BP and mean of BP change values during the hemodialysis session was used as a mortality predictor. The patients averaged 61 years old and consisted of 45% women, 32% African-Americans and 58% diabetics. Over a median follow-up of 2.2 years, a total of 53,461 (47.2%) all-cause and 21,548 (25.7%) cardiovascular deaths occurred. In fully adjusted Cox regression model with restricted cubic splines, there was a U-shaped association between change systolic BP and all-cause mortality. Post-dialytic drops in systolic BP between −30 to 0 mmHg were associated with greater survival, but large decreases of systolic BP (more than −30 mmHg) and any increase in systolic BP (over 0 mmHg) were related to increased mortality. Peak survival was found at a change in systolic BP of −14 mmHg. The U-shaped association was also found for cardiovascular mortality. Thus, modest declines in BP after hemodialysis are associated with the greatest survival, whereas any rise or large decline in BP is associated with worsened survival.

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Section: Introductionmentioning

confidence: 99%

A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival

Park

Rhee

Sim

et al. 2013

Kidney International

134

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“…Postdialysis rather than predialysis BP was found to be independently related to increased mortality. 18,19 Since the development and clinical application of ambulatory BP monitoring (ABPM), various studies have shown that assessing the circadian BP profile is more predictive than office BP readings in estimating cardiovascular risk. [20][21][22] ABPM has been generally considered as the most accurate method for evaluating BP overload in the general population as well as in HD patients.…”

Section: Discussionmentioning

confidence: 99%

Impact of Volume Status on Blood Pressure and Left Ventricle Structure in Patients Undergoing Chronic Hemodialysis

Koç¹,

Ünsal²,

Kayabaşı³

et al. 2011

Renal Failure

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In this study, we aimed to examine the impact of volume status on blood pressure (BP) and on left ventricular mass index (LVMI) in chronic hemodialysis (HD) patients. This study enrolled 74 patients (F/M: 36/38, mean age 53.5 ± 15.3 years, mean HD time 41.5 ± 41 months) that were on HD treatment for at least 3 months. Demographics, biochemical tests, hemogram and C-reactive protein levels, mean interdialytic weight gain (IDWG), mean percentage of ultrafiltration (UF), and intradialytic complications such as hypotension and cramps were determined. Mean values of predialysis and postdialysis BP measurements were recorded a month before echocardiographic examination. On the day after a midweek dialysis session, 24 h ambulatory BP monitoring (ABPM) and echocardiographic examination were made concurrently. The patients were classified into two groups according to volume status: normovolemic (group 1; 14F/24M, mean age 50 ± 16.7 years, mean dialysis time 47.7 ± 47.7 months) and hypervolemic (group 2; 15F/21M, mean age 57.3 ± 12.7 years, mean dialysis time 34.9 ± 32 months). HD duration, IDWG, UF, and interdialytic complication rates were similar between the two groups (p < 0.05). Eleven patients (28.9%) of group 1 and 8 patients (22.2%) of group 2 showed dipper (p = 0.50). Valvular damage was more common in group 2 (p = 0.002). Whereas 33 patients (91.7%) had left ventricular hypertrophy (LVH) in group 2, 21 patients of the group 1 (55.3%) had LVH (p < 0.001). Although LVMI showed a significant positive correlation with cardiothoracic index, predialysis and postdialysis BP, IDWG, UF, daytime and nighttime BP measurements of 24 h ABPM, a significant negative correlation was seen with Kt/V urea and serum albumin levels. In conclusion, increased IDWG and UF and elevated BP are independent predictors of LVH for HD patients. Increased volume status leads to IDWG and elevated BP and eventually causes severe LVMI increases.

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“…Systolic ABPM was modeled as the dependent variable against age, sex, race, predialysis and postdialysis BP. The average systolic ABPM was related to the dependent variables by the following relationship: 33.74 + 0.13 Â age + 0.66 (average of predialysis and postdialysis systolic [15] studied 60 hemodialysis patients with interdialytic ABPM and dialysis unit BP measured in a standardized manner using auscultatory or oscillometric techniques before and after dialysis. They noted modest correlation of 0.52 between predialysis and ABPM and 0.61 between postdialysis BP and ABPM.…”

Section: Discussionmentioning

confidence: 99%

“…Our population was larger, had predialysis and postdialysis BP recorded by the routine methods as measured by Coomer et al [14], and using standardized methods used by Mendes et al [15]. We used the average of six predialysis and postdialysis BPs instead of using only two.…”

Section: Discussionmentioning

confidence: 99%

Dialysis dose and the diagnosis of hypertension in hemodialysis patients

Agarwal¹,

Saha

2007

Blood Pressure Monitoring

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The use of peridialysis blood pressure and intradialytic blood pressure changes in the prediction of interdialytic blood pressure in haemodialysis patients

Cited by 22 publications

References 20 publications

A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival

A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival

Impact of Volume Status on Blood Pressure and Left Ventricle Structure in Patients Undergoing Chronic Hemodialysis

Dialysis dose and the diagnosis of hypertension in hemodialysis patients

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