#4319 ASSOCIATION BETWEEN INTRADIALYTIC HYPERTENSION FREQUENCY AND SHORT-TERM CLINICAL OUTCOMES AMONG ESRD PATIENTS RECEIVING HEMODIALYSIS

Abstract

Abstract Background and Aims Systolic blood pressure (SBP) pattern in hemodialysis (HD) is typically characterized by a rapid decrease during the start of HD and followed by a more gradual decline in the latter part of the treatment. Deviation from the typical BP trend with a paradoxical rise in BP during HD, has been associated with increased mortality and morbidity and therefore, could be a modifiable risk marker for short-term adverse events in this population. Physicians may usually pay more attention to the more common complication that is hypotension during dialysis than the pattern of BP rise, hence overlooking a significant marker for poor prognosis. This study aims to investigate the association of intradialytic hypertension with short-term 30-day clinical outcomes including hospitalizations and mortality. Previous observational studies have suggested that changes in blood pressure during dialysis is associated with mortality and morbidity, however, the exact mechanism is still unclear. Method This study is a prospective cohort study of ESRD patients receiving in-center maintenance hemodialysis in a tertiary hospital in Davao City. All patients who were more than 18 years old and at least 1-year hemodialysis vintage were included. The study collected data from patients within a 30-day observation period and recorded the occurrence of events within the next 30-day follow-up period. Data collection was done from July 2022 to August 2022. Results In this study, patients had an average age of 49.18 years, majority of 55.56% were male and the most common cause of ESRD was glomerular disease. This study demonstrates that the incidence of intradialytic hypertension in this institution is high at 49.38%. Among the 81 enrolled patients, 16% had short term outcomes. Among the patients, 13.5% were hospitalized within the follow-up period and majority of 63.6% of them had IDH. All of the 2.47% of patients who expired during the follow-up period had IDH. Patients who had concomitant heart failure (p-value <0.001), has non-tunneled catheter as vascular access (p-value 0.004), high intradialytic frequency of 50–87.5% (p-value <0.001), and interdialytic weight gain of at least 2 kilograms (p-value 0.029) were significantly associated with hospitalization and mortality within 30 days. Conclusion The results of this study recommends that prompt attention should be given to ESRD patients who exhibit IDH as this may be a risk marker for adverse short term events within 30 days. In line with this, setting of dry weight, screening for heart failure, conversion to permanent AVF access, and tailoring of anti-hypertensive medications for better BP control should be assessed with vigilance in the dialysis unit.