Intradialytic hypertension is a marker of volume excess.

[okarol]

Nephrol Dial Transplant. 2010 Apr 16. [Epub ahead of print]
Intradialytic hypertension is a marker of volume excess.

Agarwal R, Light RP.

1Division of Nephrology, Department of Medicine, Indiana University School of Medicine, Indianapolis, IN USA.
Abstract

BACKGROUND: Intradialytic blood pressure (BP) profiles have been associated with all-cause mortality, but its pathophysiology remains unknown. We tested the hypothesis that intradialytic changes in BP reflect excess volume. METHODS: The dry weight reduction in hypertensive haemodialysis patients (DRIP) trial probed dry weight in 100 prevalent haemodialysis patients; 50 patients who did not have their dry weight probed served as time controls. In this post hoc analysis, intradialytic BP was recorded at each of the 30 dialysis treatments during the trial. The slope of intradialytic BP over dialysis was calculated by the log of BP regressed over time. Using a linear mixed model, we compared these slopes between control and ultrafiltration groups at baseline and over time, tested the effect of dry weight reduction on these slopes and finally tested the ability of change in intradialytic slopes to predict change in interdialytic systolic BP. RESULTS: At baseline, intradialytic systolic and diastolic BP dropped at a rate of approximately 3%/h (P < 0.0001). Over the course of the trial, compared to the control group, the slopes steepened in the ultrafiltration group for systolic but not diastolic BP. Those who lost the most post-dialysis weight from baseline to 4 weeks and baseline to 8 weeks also experienced the greatest steepening of slopes. Each percent per hour steepening of the intradialytic systolic BP slope was associated with 0.71 mmHg [95% confidence interval (CI) 0.01-1.42, P = 0. 048] reduction in interdialytic ambulatory systolic pressure. CONCLUSIONS: Intradialytic BP changes appear to be associated with change in dry weight among haemodialysis patients. Among long-term haemodialysis patients, intradialytic hypertension may, thus, be a sign of volume overload.

PMID: 20400448 [PubMed - as supplied by publisher]

(("2010/04/01"[PDAT] : "2010/04/30"[PDAT]) AND (("dialysis"[MeSH Terms] OR "dialysis"[All Fields]) OR "renal transplant"[All Fields] OR "chronic kidney disease"[All Fields] OR "renal replacement therapy"[All Fields])) AND ("fluid management"[All Fields] OR "dry weight"[All Fields]) AND English[lang] AND ("Adv Chronic Kidney Dis"[Journal] OR "Am J Kidney Dis"[Journal] OR "Am J Nephrol"[Journal] OR "Artif Organs"[Journal] OR "Blood Purif"[Journal] OR "BMC Nephrol"[Journal] OR "Clin J Am Soc Nephrol"[Journal] OR "Dial Transplant"[Journal] OR "Hemodial Int"[Journal] OR "Int J Artif Organs"[Journal] OR "J Am Soc Nephrol"[Journal] OR "J Ren Care"[Journal] OR "J Ren Nutr"[Journal] OR "J Vasc Access"[Journal] OR "Kidney Int"[Journal] OR "Nephrol Dial Transplant"[Journal] OR "NDT Plus"[Journal] OR "Nephrol News Issues "[Journal] OR "Nephrol Nurs J"[Journal] OR "Nephron Clin Pract"[Journal] OR "Pediatr Nephrol"[Journal] OR "Perit Dial Int"[Journal] OR "Semin Dial"[Journal] OR "Ther Apher Dial"[Journal])