Pre-dialytic Systolic Blood Pressure is an Independent Predictor of Intradialytic Hypertension

Achmad Rifai; Dwi Soelistyoningsih; Jonny Karunia Fajar; Atma Gunawan

doi:10.3889/oamjms.2022.8280

Authors

Achmad Rifai Department of Internal Medicine, Division of Nephrology & Hypertension, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia; Hemodialysis Center, Universitas Muhammadiyah, Malang Hospital, Malang, Indonesia
Dwi Soelistyoningsih Department of Nursing, Sekolah Tinggi Ilmu Kesehatan Widyagama Husada, Malang, Indonesia; Department of Medical Science (Doctoral Program), Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia https://orcid.org/0000-0002-0668-4971
Jonny Karunia Fajar Department of Internal Medicine, Brawijaya Internal Medicine Research Center, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
Atma Gunawan Department of Internal Medicine, Division of Nephrology & Hypertension, Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia

DOI:

https://doi.org/10.3889/oamjms.2022.8280

Keywords:

Intradialytic hypertension, Pre-dialytic systolic blood pressure, Hemodialysis, Predictors

Abstract

BACKGROUND: Since endothelial dysfunction and activation of renin-angiotensin aldosterone system are the primary mechanism of intradialytic hypertension (IDHT), the assessment of pre dialytic blood pressure might provide an important information for the prediction of IDHT.

OBJECTIVES: To assess the association between pre dialytic blood pressure and the risk of IDHT.

METHODS: We conducted a cross-sectional study in Universitas Muhammadiyah Malang Hospital. The inclusion criteria were all hemodialysis patients aged more than 18 years, and the exclusion criteria were patients with hemodialysis duration of less than three months, patients with poor compliance to consume antihypertensive drugs, and hemodynamically unstable. The predictor variable was pre dialytic systolic blood pressure and the outcome was the incidence of IDHT. The association between pre dialytic blood pressure and the risk of IDHT was assessed using multiple logistic regression.

RESULTS: A total of 36 patients with IDHT and 60 patients without IDHT was enrolled in our study. Our study identified that pre dialytic systolic blood pressure was associated with the risk of IDHT, with mean difference was 10.90 mmHg between patients with IDHT and without IDHT. Our study confirmed that the levels of pre dialytic systolic blood pressure 135 mmHg was the optimal cut off, and we found that patients with pre dialytic systolic blood pressure ≥ 135 mmHg had 4.60-fold to develop IDHT compared to patients with pre dialytic systolic blood pressure < 135 mmHg.

CONCLUSION: Our study reveals that pre dialytic systolic blood pressure is an important predictor of IDHT.

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References

Inrig JK. Intradialytic hypertension: A less-recognized cardiovascular complication of hemodialysis. Am J Kidney Dis. 2010;55(3):580-9. https://doi.org/10.1053/j.ajkd.2009.08.013 PMid:19853337 DOI: https://doi.org/10.1053/j.ajkd.2009.08.013

Van Buren PN, Kim C, Toto RD, Inrig JK. The prevalence of persistent intradialytic hypertension in a hemodialysis population with extended follow-up. Int J Artif Organs. 2012;35(12):1031-8. https://doi.org/10.5301/ijao.5000126 PMid:23065874 DOI: https://doi.org/10.5301/ijao.5000126

Eftimovska-Otovic N, Grozdanovski R, Taneva B, Stojceva- Taneva O. Clinical characteristics of patients with intradialytic hypertension. Pril (Makedon Akad Nauk Umet Odd Med Nauki). 2015;36(2):187-93. https://doi.org/10.1515/prilozi-2015-0066 PMid:27442384 DOI: https://doi.org/10.1515/prilozi-2015-0066

Timofte D, Tanasescu MD, Balan DG, Tulin A, Stiru O, Vacaroiu IA, et al. Management of acute intradialytic cardiovascular complications: Updated overview (review). Exp Ther Med. 2021;21:282. https://doi.org/10.3892/etm.2021.9713 PMid:33603889 DOI: https://doi.org/10.3892/etm.2021.9713

Kale G, Mali M, Bhangale A, Somani J, Jeloka T. Intradialytic hypertension increases non-access related hospitalization and mortality in maintenance hemodialysis patients. Indian J Nephrol. 2020;30(2):85-90. https://doi.org/10.4103/ijn.IJN_153_19 PMid:32269431 DOI: https://doi.org/10.4103/ijn.IJN_153_19

Perdhana L, Chasani S. 42. Intradialytic hypertension and six month-all cause mortality in hemodialysis patients. J Hypertens. 2021;39:e11. DOI: https://doi.org/10.1097/01.hjh.0000752516.20104.12

Fajar JK. Supplementary files: Pre dialytic systolic blood pressure is the independent predictor of intradialytic hypertension. Figshare Dataset. 2021;1:1.

Georgianos PI, Sarafidis PA, Zoccali C. Intradialysis hypertension in end-stage renal disease patients: Clinical epidemiology, pathogenesis, and treatment. Hypertension. 2015;66(3):456-63. https://doi.org/10.1161/HYPERTENSIONAHA.115.05858 PMid:26150436 DOI: https://doi.org/10.1161/HYPERTENSIONAHA.115.05858

Raikou VD, Kyriaki D. The association between intradialytic hypertension and metabolic disorders in end stage renal disease. Int J Hypertens. 2018;2018:1681056. PMid:29850223 DOI: https://doi.org/10.1155/2018/1681056

Inrig JK, Van Buren P, Kim C, Vongpatanasin W, Povsic TJ, Toto RD. Intradialytic hypertension and its association with endothelial cell dysfunction. Clin J Am Soc Nephrol. 2011;6(8):2016-24. https://doi.org/10.2215/CJN.11351210 PMid:21757643 DOI: https://doi.org/10.2215/CJN.11351210

Van Buren PN, Toto R, Inrig JK. Interdialytic ambulatory blood pressure in patients with intradialytic hypertension. Curr Opin Nephrol Hypertens. 2012;21(1):15-23. https://doi.org/10.1097/MNH.0b013e32834db3e4 PMid:22123207 DOI: https://doi.org/10.1097/MNH.0b013e32834db3e4

Karpetas A, Loutradis C, Bikos A, Tzanis G, Koutroumpas G, Lazaridis AA, et al. Blood pressure variability is increasing from the first to the second day of the interdialytic interval in hemodialysis patients. J Hypertens. 2017;35(12):2517-26. https://doi.org/10.1097/HJH.0000000000001478 PMid:28806350 DOI: https://doi.org/10.1097/HJH.0000000000001478

Sarafidis PA, Loutradis C, Karpetas A, Tzanis G, Bikos A, Raptis V, et al. The association of interdialytic blood pressure variability with cardiovascular events and all-cause mortality in haemodialysis patients. Nephrol Dial Transplant. 2019;34(3):515-23. https://doi.org/10.1093/ndt/gfy247 PMid:30184172 DOI: https://doi.org/10.1093/ndt/gfy247

Shafiee M, Jahromi SE, Jalali GA. Ambulatory Blood pressure monitoring in hemodialysis patients with intradialytic hypertension. Iran J Kidney Dis. 2020;14(2):133-8. PMid:32165598

Van Buren PN. Pathophysiology and implications of intradialytic hypertension. Curr Opin Nephrol Hypertens. 2017;26(4):303-10. https://doi.org/10.1097/MNH.0000000000000334 PMid:28399019 DOI: https://doi.org/10.1097/MNH.0000000000000334

Van Buren PN. Evaluation and treatment of hypertension in end-stage renal disease patients on hemodialysis. Curr Cardiol Rep. 2016;18(12):125. https://doi.org/10.1007/s11886-016-0805-y PMid:27796862 DOI: https://doi.org/10.1007/s11886-016-0805-y

Assimon MM, Flythe JE. Intradialytic blood pressure abnormalities: The highs, the lows and all that lies between. Am J Nephrol. 2015;42(5):337-50. https://doi.org/10.1159/000441982 PMid:26584275 DOI: https://doi.org/10.1159/000441982

Ali Z, Riyadi I, Akbar YA, Rahadiyanto KY. Association of plasma asymmetric dimethylarginine concentration changes with intradialytic hypotension and hypertension in chronic hemodialysis patients. J Phys Conf Ser. 2019;2019:012003. DOI: https://doi.org/10.1088/1742-6596/1246/1/012003

Inrig JK, Van Buren P, Kim C, Vongpatanasin W, Povsic TJ, Toto R. Probing the mechanisms of intradialytic hypertension: A pilot study targeting endothelial cell dysfunction. Clin J Am Soc Nephrol. 2012;7(8):1300-9. https://doi.org/10.2215/CJN.10010911 PMid:22700888 DOI: https://doi.org/10.2215/CJN.10010911