1
|
Adejumo OA, Edeki IR, Oyedepo DS, Yisau OE, Ige OO, Ekrikpo IU, Moussa AS, Palencia H, Noubiap JJ, Ekrikpo UE. The prevalence and risk of mortality associated with intradialytic hypertension among patients with end-stage kidney disease on haemodialysis: A systematic review and meta-analysis. PLoS One 2024; 19:e0304633. [PMID: 38861528 PMCID: PMC11166311 DOI: 10.1371/journal.pone.0304633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 05/15/2024] [Indexed: 06/13/2024] Open
Abstract
INTRODUCTION Intradialytic hypertension (IDHTN) is a common but less frequently recognised complication of haemodialysis. However, it is associated with increased overall mortality in patients on haemodialysis. This systematic review and meta-analysis aimed to determine the prevalence of IDHTN and associated mortality risk in the global haemodialysis population. METHOD A systematic search of PubMed and EMBASE was undertaken to identify articles with relevant data published between 1990 and 2023. The pooled prevalence of IDHTN in the global haemodialysis population was determined using the DerSimonian-Laird random-effects meta-analysis. The pooled hazards ratio for mortality in patients with IDHTN was also computed from the studies that reported mortality among haemodialysis patients with IDHTN. The study protocol was registered with PROSPERO (CRD42023388278). RESULTS Thirty-two articles from 17 countries were included, with a pooled population of 127,080 hemodialysis patients (median age 55.1 years, 38.2% females). Most studies had medium methodological quality (53.1%, n = 17). The overall pooled prevalence of IDHTN was 26.6% [(95% CI 20.2-33.4%), n = 27 studies, I2 = 99.3%, p<0.001 for heterogeneity], with significant differences depending on the definition used. The pooled proportion of haemodialysis sessions with IDHTN was 19.9% [(95% 12.5-28.6%, n = 8 studies, I2 = 99.3%, p<0.001 for heterogeneity)] with significant differences across the different definition criteria. The p-value for the Begg test was 0.85. The median pre-dialysis blood pressure was not significantly associated with IDHTN. The pooled hazard ratio for mortality was 1.37 (95% CI 1.09-1.65), n = 5 studies, I2 = 13.7%, and p-value for heterogeneity = 0.33. CONCLUSION The prevalence of IDHTN is high and varies widely according to the definition used. A consensus definition of IDHTN is needed to promote uniformity in research and management. The increased mortality risk forecasted by IDHTN highlights the need for optimal blood pressure control in patients on hemodialysis.
Collapse
Affiliation(s)
| | | | - Dapo Sunday Oyedepo
- Department of Internal Medicine, University of Ilorin Teaching Hospital, Kwara State, Nigeria
| | - Olawale Elijah Yisau
- Department of Internal Medicine, University of Medical Sciences, Ondo State, Nigeria
| | | | - Inyeneabasi Udeme Ekrikpo
- Department of Biology, Western Kentucky University, Bowling Green, Kentucky, United States of America
| | | | - Hansel Palencia
- International Clinical Team, DaVita International, London, United Kingdom
| | - Jean Jacques Noubiap
- Division of Cardiology, Department of Medicine, University of California - San Francisco, San Francisco, California, United States of America
| | - Udeme Ekpenyong Ekrikpo
- Research Team, DaVita HealthCare, Riyadh, Saudi Arabia
- Department of Internal Medicine, University of Uyo, Akwa Ibom State, Nigeria
| |
Collapse
|
2
|
Sasaki S, Raita Y, Murakami M, Yamamoto S, Tochitani K, Hasegawa T, Fujisaki K, Fukuhara S. Added value of clinical prediction rules for bacteremia in hemodialysis patients: An external validation study. PLoS One 2021; 16:e0247624. [PMID: 33617601 PMCID: PMC7899347 DOI: 10.1371/journal.pone.0247624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 02/09/2021] [Indexed: 12/29/2022] Open
Abstract
Introduction Having developed a clinical prediction rule (CPR) for bacteremia among hemodialysis (HD) outpatients (BAC-HD score), we performed external validation. Materials & methods Data were collected on maintenance HD patients at two Japanese tertiary-care hospitals from January 2013 to December 2015. We enrolled 429 consecutive patients (aged ≥ 18 y) on maintenance HD who had had two sets of blood cultures drawn on admission to assess for bacteremia. We validated the predictive ability of the CPR using two validation cohorts. Index tests were the BAC-HD score and a CPR developed by Shapiro et al. The outcome was bacteremia, based on the results of the admission blood cultures. For added value, we also measured changes in the area under the receiver operating characteristic curve (AUC) using logistic regression and Net Reclassification Improvement (NRI), in which each CPR was added to the basic model. Results In Validation cohort 1 (360 subjects), compared to a Model 1 (Basic Model) AUC of 0.69 (95% confidence interval [95% CI]: 0.59–0.80), the AUC of Model 2 (Basic model + BAC-HD score) and Model 3 (Basic model + Shapiro’s score) increased to 0.8 (95% CI: 0.71–0.88) and 0.73 (95% CI: 0.63–0.83), respectively. In validation cohort 2 (96 subjects), compared to a Model 1 AUC of 0.81 (95% CI: 0.68–0.94), the AUCs of Model 2 and Model 3 increased to 0.83 (95% CI: 0.72–0.95) and 0.85 (95% CI: 0.76–0.94), respectively. NRIs on addition of the BAC-HD score and Shapiro’s score were 0.3 and 0.06 in Validation cohort 1, and 0.27 and 0.13, respectively, in Validation cohort 2. Conclusion Either the BAC-HD score or Shapiro’s score may improve the ability to diagnose bacteremia in HD patients. Reclassification was better with the BAC-HD score.
Collapse
Affiliation(s)
- Sho Sasaki
- Department of Nephrology, Iizuka Hospital, Fukuoka, Japan
- Clinical Research Support Office, Iizuka Hospital, Fukuoka, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan
- * E-mail:
| | - Yoshihiko Raita
- Department of Nephrology, Okinawa Prefectural Chubu Hospital, Naha, Japan
- Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Minoru Murakami
- Department of Nephrology, Saku Central Hospital, Nagano, Japan
| | - Shungo Yamamoto
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan
- Department of Infectious Disease, Kyoto City Hospital, Kyoto, Japan
| | - Kentaro Tochitani
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Public Health, Kyoto, Japan
- Department of Infectious Disease, Kyoto City Hospital, Kyoto, Japan
| | - Takeshi Hasegawa
- Office for Promoting Medical Research, Showa University, Tokyo, Japan
- Division of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan
- Fukushima Medical University, Fukushima, Japan
| | | | - Shunichi Fukuhara
- Fukushima Medical University, Fukushima, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University, Kyoto, Japan
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
| |
Collapse
|
3
|
Ito T, Fujimoto N, Ishikawa E, Dohi K, Fujimoto M, Murata T, Kiyohara M, Takeuchi H, Koyabu S, Nishimura H, Takeuchi T, Ito M. The effect of an L/N-type calcium channel blocker on intradialytic blood pressure in intradialytic hypertensive patients. Clin Exp Hypertens 2018; 41:92-99. [PMID: 29584458 DOI: 10.1080/10641963.2018.1445753] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Intradialytic hypertension (HTN), which is one of the poor prognostic markers in patients undergoing hemodialysis, may be associated with sympathetic overactivity. The L/N-type calcium channel blocker, cilnidipine, has been reported to suppress sympathetic nerves activity in vivo. Therefore, we hypothesized that cilnidipine could attenuate intradialytic systolic blood pressure (SBP) elevation. METHODS Fifty-one patients on chronic hemodialysis who had intradialytic-HTN (SBP elevation ≥10 mmHg during hemodialysis) and no fluid overload were prospectively randomized into two groups: control and cilnidipine groups. Cilnidipine group patients took cilnidipine (10 mg/day) for 12 weeks. The primary endpoint was the change in the intradialytic SBP elevation before and after the 12-week intervention. RESULTS Before the intervention, no differences were observed in age, sex or pre-dialytic SBP (148.5 ± 12.9 vs. 148.3 ± 19.3 mmHg) between the two groups. Intradialytic SBP elevation was unchanged in the control group. Cilnidipine significantly lowered the post-dialytic SBP with an attenuation of the intradialytic SBP elevation from 12.0 ± 15.4 mmHg to 4.8 ± 10.1 mmHg. However, the observed difference in the intradialytic SBP elevation by cilnidipine did not reach statistical significance (group×time interaction effect p = 0.25). Cathecolamine levels were unaffected by the intervention in both groups. CONCLUSION Cilnidipine lowers both the pre- and post-dialytic SBP and might attenuate intradialytic SBP elevation. Therefore, cilnidipine may be effective in lowering SBP during HD in patients with intradialytic-HTN.
Collapse
Affiliation(s)
- Takayasu Ito
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Naoki Fujimoto
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Eiji Ishikawa
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Kaoru Dohi
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Mika Fujimoto
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Tomohiro Murata
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| | - Michiyo Kiyohara
- b Department of Internal medicine , Takeuchi Hospital , Tsu , Japan
| | | | - Sukenari Koyabu
- c Department of Hemodialysis center , Owase General Hospital , Owase , Japan
| | | | | | - Masaaki Ito
- a Department of Cardiology and Nephrology , Mie University Graduate School of Medicine , Tsu , Japan
| |
Collapse
|
4
|
Gulin M, Klarić D, Ilić M, Radić J, Kovačić V, Šain M. Blood Pressure of Maintenance Hemodialysis Patients in the Dalmatian Region of Croatia: Differences between Hospital and Out-of-Hospital Dialysis Centers. Blood Purif 2017; 44:110-121. [PMID: 28571010 DOI: 10.1159/000474931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 04/02/2017] [Indexed: 11/19/2022]
Abstract
AIMS This study was aimed at comparing the incidence of arterial hypertension and blood pressure (BP) variance in hospital and out-of-hospital hemodialysis (HD) patients during HD sessions. METHODS A cross-sectional study was conducted for 1 week at all the HD centers in Dalmatia, Croatia. The pre-, intra-, and post-dialysis BP values were collected for 3 consecutive HD sessions per patient. RESULTS Of the 399 subjects, 73.9% were hypertensives, who showed higher interdialytic weight gain compared to the normotensives (2.58 vs. 2.40). Hospital and out-of-hospital HD patients received identical antihypertensive therapies, except that beta blockers were more frequently administered to out-of-hospital HD patients. Higher pre-, intra-, and post-dialysis BP values were recorded in patients at out-of-hospital HD centers. CONCLUSION The differences in BP variability and antihypertensive therapies administered to hospital HD patients as compared to out-of-hospital HD patients may reflect differing approaches by the nephrologists at these centers.
Collapse
Affiliation(s)
- Marijana Gulin
- Department of Nephrology and Dialysis, Šibenik General Hospital, Šibenik, Croatia
| | | | | | | | | | | |
Collapse
|
5
|
Ogata H, Kumasawa J, Fukuma S, Mizobuchi M, Kinugasa E, Fukagawa M, Fukuhara S, Akizawa T. The cardiothoracic ratio and all-cause and cardiovascular disease mortality in patients undergoing maintenance hemodialysis: results of the MBD-5D study. Clin Exp Nephrol 2017; 21:797-806. [PMID: 28508128 PMCID: PMC5648748 DOI: 10.1007/s10157-017-1380-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Accepted: 01/04/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND The cardiothoracic ratio (CTR) is a non-invasive left ventricular hypertrophy index. However, whether CTR associates with cardiovascular disease (CVD) and mortality in hemodialysis (HD) populations is unclear. METHODS Using a Mineral and Bone disorder Outcomes Study for Japanese CKD Stage 5D Patients (MBD-5D Study) subcohort, 2266 prevalent HD patients (age 62.8 years, female 38.0%, HD duration 9.4 years) with secondary hyperparathyroidism (SHPT) whose baseline CTR had been recorded were selected. We evaluated associations between CTR and all-cause death, CVD death, or composite events in HD patients. RESULTS CTR was associated significantly with various background and laboratory characteristics. All-cause death, CVD-related death, and composite events increased across the CTR quartiles (Q). Adjusted hazard risk (HR) for all-cause death was 1.4 (95% confidential interval, 0.9-2.1) in Q2, 1.9 (1.3-2.9) in Q3, and 2.6 (1.7-4.0) in Q4, respectively (Q1 as a reference). The corresponding adjusted HR for CVD-related death was 1.8 (0.8-4.2), 3.1 (1.4-6.8), and 3.5 (1.6-7.9), and that for composite outcome was 1.2 (1.0-1.6), 1.7 (1.3-2.2), and 1.8 (1.5-2.3), respectively. Exploratory analysis revealed that there were relationships between CTR and age, sex, body mass index, comorbidity of CVD, dialysis duration and intact parathyroid hormone, phosphorus, hemoglobin, and usage of phosphate binder [corrected]. CONCLUSION CTR correlated with all-cause death, CVD death, and composite events in HD patients with SHPT.
Collapse
Affiliation(s)
- Hiroaki Ogata
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Chigsaki-chuo 35-1, Tsuzuki, Yokohama, Kanagawa, 224-8503, Japan.
| | - Junji Kumasawa
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Department of Critical Care Medicine, Sakai City Medical Center, Osaka, Japan.,Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan
| | - Shingo Fukuma
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Masahide Mizobuchi
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| | - Eriko Kinugasa
- Department of Internal Medicine, Showa University Northern Yokohama Hospital, Chigsaki-chuo 35-1, Tsuzuki, Yokohama, Kanagawa, 224-8503, Japan
| | - Masafumi Fukagawa
- Division of Nephrology, Endocrinology and Metabolism, Tokai University School of Medicine, Kanagawa, Japan
| | - Shunichi Fukuhara
- Department of Healthcare Epidemiology, Graduate School of Medicine and Public Health, Kyoto University, Kyoto, Japan.,Center for Innovative Research for Communities and Clinical Excellence (CIRC2LE), Fukushima Medical University, Fukushima, Japan
| | - Tadao Akizawa
- Division of Nephrology, Department of Medicine, Showa University School of Medicine, Tokyo, Japan
| |
Collapse
|