Original Article: Patient-Oriented, Translational Research

Profile of Interdialytic Blood Pressure in Hemodialysis Patients
Sergio F.F. Santos^a, Roger B. Mendes^a,b, Carlos A. Santos^a, David Dorigo^a, Aldo J. Peixoto<sup>c

a</sup>Division of Nephrology, State University of Rio de Janeiro, Rio de Janeiro, RJ, and
^bGrupo de Assistência Médica e Nefrológica (GAMEN), Rio de Janeiro, RJ, Brazil;
^cSection of Nephrology, Yale University School of Medicine, NewHaven, Conn., and Renal Section, VA Connecticut – West Haven Campus, West Haven, Conn., USA

Address of Corresponding Author

Am J Nephrol 2003;23:96-105 (DOI: 10.1159/000068038)

  Key Words

• Ambulatory blood pressure monitoring
• Chronic kidney failure
• Circadian rhythm
• Hemodialysis
• Hypertension

  Abstract

Background and Methods: Hypertension is a common problem in hemodialysis (HD). However, its behavior during the interdialytic period is not completely known and is infrequently monitored in clinical practice. Thus, for better understanding of interdialytic blood pressure (BP), we analyzed the interdialytic blood pressure profile using 44-hour ambulatory blood pressure monitoring (ABPM) data in 71 unselected, stable HD patients. Results: There was an increase in BP during the interdialytic period (awake day 1: 135/84 ± 23/14 mm Hg; awake day 2: 140/86 ± 22/15 mm Hg, p < 0.05; sleep day 1: 130/77 ± 24/15 mm Hg; sleep day 2: 136/80 ± 24/15 mm Hg, p < 0.05). The correlation between the average 44-hour BP and interdialytic weight gain (IDWG) was not significant (r = –0.07 for systolic BP and r = –0.09 for diastolic BP). The number of non-dipper patients was high, 77% on interdialytic day 1 and 83% on interdialytic day 2 for systolic BP. Uncontrolled hypertension (average 44 h BP ≥135/85 mm Hg) was diagnosed in 58 (55%) patients. Patients with uncontrolled hypertension had higher pre- and posthemodialysis BP, higher BP on each interdialytic day and night, and higher night/day diastolic BP ratio on the second interdialytic day. These patients were also taking a greater number of vasoactive medications (1.5 vs. 0.6 in those with controlled BP, p = 0.001). There were no significant differences related to kt/V, hematocrit, or weekly erythropoietin dose between patients with controlled or uncontrolled BP. Hemodialysis shift assignment (morning or afternoon) did not impact on BP levels or diurnal profile. Conclusion: In HD patients, interdialytic BP is often poorly controlled, there is a progressive rise in BP, and a trend toward loss of nocturnal decline in BP as the interdialytic period progresses. Further research is needed to determine whether treatment directed to interdialytic BP changes can alter outcomes in HD patients.

Copyright © 2003 S. Karger AG, Basel

  Author Contacts

Aldo J. Peixoto, MD
Renal Section – 111F, West Haven VA Medical Center
950 Campbell Ave. West Haven, CT 06510 (USA)
Tel. +1 203 932 5711, ext 3950, Fax +1 230 937 3455
E-Mail aldo.peixoto@yale.edu

  Article Information

Some of the subjects included in this paper (n = 8) were part of a previous publication [Peixoto et al: Am J Kidney Dis 2000;36:983–990].

Received: Received: July 30, 2002
Accepted: October 4, 2002
Number of Figures : 1, Number of Tables : 6, Number of References : 37