Ambulatory Blood Pressure Monitoring in Hemodialysis Patients with Intradialytic Hypertension

Introduction:

It has not yet been clear whether intradialytic hypertension (IDHN) translates into the presence of high BP between dialysis sessions or not. In this study, we aimed to perform interdialytic ambulatory blood pressure monitoring (ABPM) in patients with IDHN to find whether high BP persists at home.

Methods:

In this case-control study, ABPM was performed during a 44-hours interdialytic period in patients on maintenance hemodialysis (HD) with pre-dialysis systolic BP (SBP) above 130 mmHg. BlandAltman graphs were used to investigate the magnitude of the difference between the results of ABPM records and intradialytic BP measurements in patients with and without IDHN.

Results:

A total of 56 patients were enrolled in our study (29 in the IDHN group and 27 in the control group). The average of the pre-dialysis SBP in 6 consecutive HD treatments was 146.6 ± 11.36 vs. 146.8 ± 12.1 mmHg in IDHN and control group, respectively (P > .05). Mean post-dialysis SBP was 154.45 ± 12.6 mmHg in the IDHN group and 136.76 ± 11.50 in the control group (P < .001). Mean ± SD of 44-hour SBP was 157.31 ± 20.27 mmHg in the IDHN group, which was significantly higher than that in the control group (146.5 ± 16.67 mmHg, P < .05). No significant differences were seen in the average of interdialytic weights gain between the two groups. Compared to the pre-dialysis SBP, using BlandAltman graphs, the post-dialysis SBP (bias of 3.5 mmHg) had closer readings to the daytime SBP in the IDHN group.

 Conclusion:

Patients with IDHN had higher interdialytic BPs. Among BPs taken during HD in patients with IDHN, post-dialysis SBP had the lowest difference with the daytime SBP taken by ABPM.