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Original Paper

Can Predialysis Hypertension Prevent Intradialytic Hypotension in Hemodialysis Patients?

Takeda A.a · Toda T.a · Fujii T.a · Sasaki S.b · Matsui N.a

Author affiliations

aKidney Center, Tsuchiura Kyodo General Hospital, Tsuchiura, and bDepartment of Homeostasis Medicine and Nephrology, Tokyo Medical and Dental University, Tokyo, Japan

Related Articles for ""

Nephron Clin Pract 2006;103:c137–c143

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: June 15, 2005
Accepted: December 20, 2005
Published online: April 24, 2006
Issue release date: July 2006

Number of Print Pages: 1
Number of Figures: 3
Number of Tables: 3


eISSN: 1660-2110 (Online)

For additional information: https://www.karger.com/NEC

Abstract

Background/Aim: Intradialytic hypotension is the most common complication associated with hemodialysis, and its cause is multifactorial. However, the relationship between hypertension and intradialytic hypotension is not clear. We investigated the influence of predialysis blood pressure and antihypertensive drugs on intradialytic hypotension. Methods: Risk factors for intradialytic hypotension were analyzed in 111 patients undergoing regular hemodialysis treatment and had annual echocardiography performed. The correlation between the addition of antihypertensive medications and the incidence of intradialytic hypotensive episodes was studied in 21 hypertensive patients. Results: Based on multivariate logistic regression analysis, diabetes (odds ratio OR 8.18, 95% confidence interval CI 1.47–45.5; p = 0.016), interdialytic weight gain (OR 2.45, 95% CI 1.24–4.82; p = 0.010), ejection fraction (OR 0.88, 95% CI 0.81–0.95; p = 0.001), and left ventricular volume (OR 0.97, 95% CI 0.94–0.99; p = 0.013) were determined as risk factors for intradialytic hypotension. However, there was no association between predialysis blood pressure and intradialytic hypotension. After additional antihypertensive medications, the predialysis blood pressure fell from 175/85 mm Hg to 154/78 mm Hg (p < 0.0001/p < 0.0001). The mean 24-hour interdialytic blood pressure fell from 165/87 mm Hg to 147/80 mm Hg (p < 0.0001/p = 0.006). However, the frequency of hypotensive episodes was not increased (p = 0.77). Conclusions: Diabetes, excessive interdialytic weight gain, low ejection fraction, and low left ventricular volume are independent risk factors for intradialytic hypotension. However, no correlation was found between predialysis blood pressure values or addition of antihypertensive medications and the incidence of intradialytic hypotension. Thus, hypertension may be controlled without aggravating intradialytic hypotension in hemodialysis patients.

© 2006 S. Karger AG, Basel


References

  1. Collins AJ, Li S, Gilbertson DT, Liu J, Chen SC, Herzog CA: Chronic kidney disease and cardiovascular disease in the Medicare population. Kidney Int Suppl 2003;87:S24–S31.
    External Resources
  2. Sarnak MJ: Cardiovascular complications in chronic kidney disease. Am J Kidney Dis 2003;41(5 suppl):11–17.
  3. Franklin SS, Larson MG, Khan SA, Wong ND, Leip EP, Kannel WB, Levy D: Does the relation of blood pressure to coronary heart disease risk change with aging? The Framingham Heart Study. Circulation 2001;103:1245–1249.
  4. Iseki K, Miyasato F, Tokuyama K, Nishime K, Uehara H, Shiohira Y, Sunagawa H, Yoshihara K, Yoshi S, Toma S, Kowatari T, Wake T, Oura T, Fukiyama K: Low diastolic blood pressure, hypoalbuminemia, and risk of death in a cohort of chronic hemodialysis patients. Kidney Int 1997;51:1212–1217.
  5. Zager PG, Nikolic J, Brown RH, Campbell MA, Hunt WC, Peterson D, Van Stone J, Levey A, Meyer KB, Klag MJ, Johnson HK, Clark E, Sadler JH, Teredesai P: ‘U’ curve association of blood pressure and mortality in hemodialysis patients. Kidney Int 1998;54:561–569.
  6. Port FK, Hulbert-Shearon TE, Wolfe RA, Bloembergen WE, Golper TA, Agodoa LY, Young EW: Predialysis blood pressure and mortality risk in a national sample of maintenance hemodialysis patients. Am J Kidney Dis 1999;33:507–517.
  7. Hörl MP, Hörl WH: Hemodialysis-associated hypertension: pathophysiology and therapy. Am J Kidney Dis 2002;39:227–244.
  8. Perazella MA: Approach to patients with intradialytic hypotension: a focus on therapeutic options. Semin Dial 1999;12:175–181.
    External Resources
  9. Schreiber MJ Jr: Clinical case-based approach to understanding intradialytic hypotension. Am J Kidney Dis 2001;38(4 suppl 4):S37–S47.
    External Resources
  10. Converse RL Jr, Jacobsen TN, Jost CM, Toto RD, Grayburn PA, Obregon TM, Fouad-Tarazi F, Victor RG: Paradoxical withdrawal of reflex vasoconstriction as a cause of hemodialysis-induced hypotension. J Clin Invest 1992;90:1657–1665.
  11. Poldermans D, Man in ‘t Veld AJ, Rambaldi R, Van Den Meiracker AH, Van Den Dorpel MA, Rocchi G, Boersma E, Bax JJ, Weimar W, Roelandt JR, Zietse R: Cardiac evaluation in hypotension-prone and hypotension-resistant hemodialysis patients. Kidney Int 1999;56:1905–1911.
  12. Lee PT, Fang HC, Chen CL, Chung HM, Chiou YH, Chou KJ: High vibration perception threshold and autonomic dysfunction in hemodialysis patients with intradialysis hypotension. Kidney Int 2003;64:1089–1094.
  13. Hathaway DK, Cashion AK, Milstead EJ, Winsett RP, Cowan PA, Wicks MN, Gaber AO: Autonomic dysregulation in patients awaiting kidney transplantation. Am J Kidney Dis 1998;32:221–229.
  14. Rahman M, Dixit A, Donley V, Gupta S, Hanslik T, Lacson E, Ogundipe A, Weigel K, Smith MC: Factors associated with inadequate blood pressure control in hypertensive hemodialysis patients. Am J Kidney Dis 1999;33:498–506.
  15. Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG: Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Am J Med 2003;115:291–297.
  16. Takeda A, Toda T, Fujii T, Shinohara S, Sasaki S, Matsui N: Discordance of influence of hypertension on mortality and cardiovascular risk in hemodialysis patients. Am J Kidney Dis 2005;45:112–118.
  17. Daugirdas JT: Second generation logarithmic estimates of single-pool variable volume Kt/V: an analysis of error. J Am Soc Nephrol 1993;4:1205–1213.
  18. Devereux RB, Reichek N: Echocardiographic determination of left ventricular mass in man: anatomic validation of the method. Circulation 1977;55:613–618.
  19. Pombo JF, Troy BL, Russell RO Jr: Left ventricular volumes and ejection fraction by echocardiography. Circulation 1971;43:480–490.
  20. London GM, Marchais SJ, Guérin AP, Fabiani F, Metivier F: Cardiovascular function in hemodialysis patients; in Grünfeld JP, Bach JF, Funck-Brentano JL, Maxwell MH (eds): Advances in Nephrology. St. Louis, Mosby Year Book, 1991, vol 20, pp 249–271.
  21. Tomson CR: Echocardiographic assessment of systolic function in dialysis patients. Nephrol Dial Transplant 1990;5:325–331.
  22. Cooper BA, Aslani A, Ryan M, Zhu FY, Ibels LS, Allen BJ, Pollock CA: Comparing different methods of assessing body composition in end-stage renal failure. Kidney Int 2000;58:408–416.
  23. Agarwal R: Supervised atenolol therapy in the management of hemodialysis hypertension. Kidney Int 1999;55:1528–1535.
  24. Agarwal R, Lewis R, Davis JL, Becker B: Lisinopril therapy for hemodialysis hypertension: hemodynamic and endocrine responses. Am J Kidney Dis 2001;38:1245–1250.

Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: June 15, 2005
Accepted: December 20, 2005
Published online: April 24, 2006
Issue release date: July 2006

Number of Print Pages: 1
Number of Figures: 3
Number of Tables: 3


eISSN: 1660-2110 (Online)

For additional information: https://www.karger.com/NEC


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