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Alostaz M, Correa S, Lundy GS, Waikar SS, Mc Causland FR. Time of hemodialysis and risk of intradialytic hypotension and intradialytic hypertension in maintenance hemodialysis. J Hum Hypertens 2023; 37:880-890. [PMID: 36599899 DOI: 10.1038/s41371-022-00799-2] [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: 07/15/2022] [Revised: 12/11/2022] [Accepted: 12/21/2022] [Indexed: 01/05/2023]
Abstract
Intradialytic hypotension and intradialytic hypertension are complications of hemodialysis (HD) associated with a higher risk of cardiovascular disease (CVD) and death. Blood pressure (BP) normally fluctuates in a circadian pattern, but whether the risk of intradialytic hypotension and intradialytic hypertension varies according to the time of the HD session is unknown. We analyzed two cohorts of thrice-weekly maintenance HD (N = 1838 patients/n = 64,503 sessions from the Hemodialysis [HEMO] Study, and N = 3302 patients/n = 33,590 sessions from Satellite Healthcare). Random effects logistic regression models examined the association of HD start time (at or before 9:00 a.m. [early AM], between 9:01 a.m. and 12:00 p.m. [late AM], and at or after 12:01 p.m. [PM]) with intradialytic hypotension (defined as nadir intra-HD systolic BP (SBP) < 90 mmHg if pre-HD SBP < 160 mmHg, or <100 mmHg if pre-HD SBP ≥ 160 mmHg) and intradialytic hypertension (SBP increase ≥ 10 mmHg from pre-HD to post-HD). Compared to early AM, late AM and PM were associated with an 8% (aOR 0.92, 95% CI 0.83-1.02) and a 16% (aOR 0.84, 95% CI 0.75-0.95) lower risk of intradialytic hypotension in HEMO, respectively. Conversely, compared to early AM, a monotonic higher risk of intradialytic hypertension was observed for late AM (aOR 1.23, 95% CI 1.12-1.35) and PM (aOR 1.41, 95% CI 1.27-1.56) in HEMO. These findings were consistent in Satellite. In two large cohorts of maintenance HD, we observed a monotonic lower risk of intradialytic hypotension and a monotonic higher risk of intradialytic hypertension with later dialysis start times. Whether HD treatment allocation to certain times of the day in hypotensive-prone or hypertensive-prone patients improves outcomes deserves further investigation.
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Affiliation(s)
- Murad Alostaz
- Rosalind Franklin University of Medicine and Science, North Chicago, IL, USA
| | - Simon Correa
- Department of Internal Medicine, Yale School of Medicine, New Haven, CT, USA.
- Yale New Haven Hospital, New Haven, CT, USA.
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| | - Gavin S Lundy
- Queen's University Belfast, Belfast, Northern Ireland
| | - Sushrut S Waikar
- Renal Section, Department of Medicine, Boston University Medical Center, Boston, MA, USA
| | - Finnian R Mc Causland
- Renal Division, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
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Indhumathi E, Angraje S, Mishra B, Macha J. Is ambulatory blood pressure monitoring required for elderly hemodialysis patients during the interdialytic period? - Experience of a tertiary care center in South India. Indian J Nephrol 2022; 32:60-66. [PMID: 35283562 PMCID: PMC8916151 DOI: 10.4103/ijn.ijn_160_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 09/04/2020] [Accepted: 10/06/2020] [Indexed: 11/04/2022] Open
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Furaz Czerpak K, Gruss Vergara E, Barril Cuadrado G, Pérez Fernández E, Benavides N, de la Flor J, Mendez Á, Martín R. Usefulness of ABPM and bioimpedance for the treatment and control of hypertension in patients on chronic haemodialysis. Nefrologia 2021; 41:17-26. [PMID: 36165357 DOI: 10.1016/j.nefroe.2020.06.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 06/11/2020] [Indexed: 06/16/2023] Open
Abstract
INTRODUCTION Hypertension is very common in haemodialysis (HD) patients, and is associated with increased morbidity and mortality rates. The goals of our research were to: 1. Measure blood pressure (BP) during HD sessions; 2. Study BP in between HD sessions with 44-h Ambulatory Blood Pressure Monitoring (ABPM); 3. Evaluate changes in treatment after the ABPM; 4. Perform bioimpedance spectroscopy (BIS) on all patients and, in those hyper-hydrated or hypertensive according to ABPM, assess for changes in BP after adjusting the dry weight; 5. Identify factors associated with average systolic and diastolic BP measured by ABPM. MATERIAL AND METHODS Prospective observational study, which included 100 patients from our dialysis unit. We measured BP before and after the HD sessions for two weeks and then, mid-week, we attached the ABPM device to the patients for 44 h. Before starting the following dialysis session, we performed BIS. A second ABPM was performed on hyper-hydrated patients and patients hypertensive according to ABPM to evaluate changes in BP values. RESULTS According to the ABPM, 65% of patients had daytime BP > 135/85 mmHg, 90% night-time BP > 120/70 mmHg and 76% average BP > 130/80 mmHg; 11% had a dipper pattern, 51% non-dipper and 38% riser. The average systolic and diastolic BP readings were 4.7 mmHg (3.8%) and 1.1 mmHg (1.64%) higher on the second day. The dose of antihypertensive medication had to be lowered in 6% of patients, 9% had to stop taking it, 28% needed increased doses and 17% had to add a new drug. The pre-HD diastolic BP best matched the ABPM. After performing the bioimpedance and adjusting dry weight, there was a statistically significant decrease in all BP values. The univariate analysis showed that the average systolic BP was higher in patients with a high-calcium dialysis bath, more antihypertensive drugs and higher doses of EPO. The multivariate analysis showed significant association for EPO and number of drugs (p < 0.01). The average diastolic BP was higher in younger patients and patients with lower Charlson index, lower body mass index and less diuresis, those on higher doses of EPO and non-diabetics. The linear regression study showed age (p < 0.005), body mass index (p < 0.03) and EPO (p < 0.03) as significant variables. CONCLUSIONS Our study shows: 1. The variability of hypertension criteria according to use of BP values from during the HD session or ABPM; 2. The variability of BP in the interdialysis period; 3. That the pre-dialysis diastolic BP best corresponds with the ABPM. 4. That the use of both BIS and ABPM improves the control of BP; 5. That the dose of EPO is the most important factor associated with hypertension in our patients.
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Affiliation(s)
- Karina Furaz Czerpak
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, Spain.
| | | | | | - Elia Pérez Fernández
- Departamento de Estadística, Hospital Universitario Fundación de Alcorcón, Madrid, Spain
| | - Nardeth Benavides
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, Spain
| | - José de la Flor
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, Spain
| | - Ángel Mendez
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, Spain
| | - Roberto Martín
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, Spain
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Furaz Czerpak K, Gruss Vergara E, Barril Cuadrado G, Pérez Fernández E, Benavides N, de la Flor J, Mendez Á, Martín R. Usefulness of ABPM and bioimpedance for the treatment and control of hypertension in patients on chronic haemodialysis. Nefrologia 2020; 41:17-26. [PMID: 32950283 DOI: 10.1016/j.nefro.2020.06.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/31/2020] [Accepted: 06/11/2020] [Indexed: 10/23/2022] Open
Abstract
INTRODUCTION Hypertension is very common in haemodialysis (HD) patients, and is associated with increased morbidity and mortality rates. The goals of our research were to: 1. Measure blood pressure (BP) during HD sessions; 2. Study BP in between HD sessions with 44-hour Ambulatory Blood Pressure Monitoring (ABPM); 3. Identify differences between the BP recorded during HD and with the ABPM; 4. Evaluate changes in treatment after the ABPM; 5. Perform bioimpedance spectroscopy (BIS) on all patients and, in those hyper-hydrated or hypertensive according to ABPM, assess for changes in BP after adjusting the dry weight; 6. Identify factors associated with average systolic and diastolic BP measured by ABPM. MATERIAL AND METHODS Prospective observational study, which included 100 patients from our dialysis unit. We measured BP before and after the HD sessions for two weeks and then, mid-week, we attached the ABPM device to the patients for 44 hours. Before starting the following dialysis session, we performed BIS. A second ABPM was performed on hyper-hydrated patients and patients hypertensive according to ABPM to evaluate changes in BP values. RESULTS According to the ABPM, 65% of patients had daytime BP > 135/85 mmHg, 90% night-time BP > 120/70 mmHg and 76% average BP > 130/80 mmHg; 11% had a dipper pattern, 51% non-dipper and 38% riser. The average systolic and diastolic BP readings were 4.7 mmHg (3.8%) and 1.1 mmHg (1.64%) higher on the second day. The dose of antihypertensive medication had to be lowered in 6% of patients, 9% had to stop taking it, 28% needed increased doses and 17% had to add a new drug. The pre-HD diastolic BP best matched the ABPM. After performing the bioimpedance and adjusting dry weight, there was a statistically significant decrease in all BP values. The univariate analysis showed that the average systolic BP was higher in patients with a high-calcium dialysis bath, more antihypertensive drugs and higher doses of EPO. The multivariate analysis showed significant association for EPO and number of drugs (p < 0.01). The average diastolic BP was higher in younger patients and patients with lower Charlson index, lower body mass index and less diuresis, those on higher doses of EPO and non-diabetics. The linear regression study showed age (p < 0.005), body mass index (p < 0.03) and EPO (p < 0.03) as significant variables. CONCLUSIONS Our study shows: 1. The variability of hypertension criteria according to use of BP values from during the HD session or ABPM; 2. The variability of BP in the interdialysis period; 3. That the pre-dialysis diastolic BP best corresponds with the ABPM. 4. That the use of both BIS and ABPM improves the control of BP; 5. That the dose of EPO is the most important factor associated with hypertension in our patients.
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Affiliation(s)
- Karina Furaz Czerpak
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, España.
| | | | | | - Elia Pérez Fernández
- Departamento de Estadística. Hospital Universitario Fundación de Alcorcón, Madrid, España
| | - Nardeth Benavides
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, España
| | - José de la Flor
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, España
| | - Ángel Mendez
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, España
| | - Roberto Martín
- Centro de Diálisis Los Llanos, Fundación Renal Íñigo Álvarez de Toledo (FRIAT), Madrid, España
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Li X, Jiang Q, Wu W, Xu X, Miao L, Jin L, Xue L, Huang T, Di J, Liu J, He X. Night-time blood pressure and pulse wave velocity in dialysis patients. Clin Exp Nephrol 2017; 22:173-178. [PMID: 28791560 DOI: 10.1007/s10157-017-1464-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Accepted: 06/20/2017] [Indexed: 12/20/2022]
Abstract
BACKGROUND Ambulatory blood pressure (ABP) monitoring and carotid-femoral pulse wave velocity (cfPWV) provide important cardiovascular risk information for dialysis patients. This study aims to evaluate the risk factors of cfPWV and the associations between ambulatory blood pressure, especially night-time blood pressure and cfPWV. METHODS We conducted a cross-sectional study in patients on maintenance hemodialysis. ABP and cfPWV were measured on a midweek interdialytic day. Associations were determined using Pearson's correlation analysis and multiple stepwise regression model. RESULTS Systolic BPs and pulse pressures, but not diastolic BPs, were significantly and positively associated with cfPWV. In a stepwise regression model, age, diabetes mellitus and all-period systolic BP were independently associated with cfPWV. When day-time and night-time BPs were included in the analysis, respectively, only night-time systolic BP and age remained as independently associated with cfPWV. CONCLUSION Ambulatory BPs are potent associates of cfPWV and night-time systolic BP, rather than day-time BPs, is an independently predictor of cfPWV. Our results support the view that controlling of nocturnal hypertension provides a unique cardiovascular protection effect.
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Affiliation(s)
- Xiurong Li
- Department of Hemodialysis, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Qingbo Jiang
- Department of Laboratory, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Wenhui Wu
- Department of Hemodialysis, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xianlin Xu
- Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Liying Miao
- Department of Hemodialysis, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Lina Jin
- Department of Hemodialysis, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Lina Xue
- Department of Hemodialysis, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Tian Huang
- Department of Hemodialysis, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jia Di
- Department of Hemodialysis, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Jinfeng Liu
- Department of Hemodialysis, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Laboratory, The Third Affiliated Hospital of Soochow University, Changzhou, China.,Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xiaozhou He
- Department of Hemodialysis, The Third Affiliated Hospital of Soochow University, Changzhou, China. .,Department of Urology, The Third Affiliated Hospital of Soochow University, Changzhou, China.
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