Association of dialysis shift with morning surge in blood pressure and dipping pattern.

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Blood pressure (BP) present a diurnal pattern with a nocturnal decrease and an increase in early morning. Evidence suggests that an exaggerated morning BP surge is associated with higher cardiovascular risk. This is the first study evaluating the association between dialysis timing and morning BP surge in hemodialysis. 113 patients dialyzed on the morning shift were age- and sex-matched in a 1:1 ratio with 113 patients dialyzed on the midday/evening shifts. All patients underwent 48-h ambulatory BP monitoring. Morning BP surge at the first and second days of the recording was calculated using three definitions: pre-awakening, sleep-trough and rising morning BP surge. The two groups were similar in terms of age, BMI and comorbidities. Morning shift patients presented higher mean sleep-through SBP/DBP surges (SBP: 18.71 ± 13.11 vs 14.22 ± 10.25mmHg, p = 0.005; DBP: 12.05 ± 8.04 vs 9.46 ± 8.53mmHg, p = 0.020) and higher mean pre-awakening SBP/DBP surges (SBP: 12.05 ± 8.04 vs 9.46 ± 8.53mmHg, p = 0.020; DBP: 10.16 ± 9.56 vs 6.53 ± 10.78mmHg, p = 0.008). No between-groups differences were observed in mean rising SBP surge. During the 1st 24-h period, morning shift patients showed higher pre-awakening SBP/DBP surges (SBP: 9.85 ± 11.15 vs 6.22 ± 11.77mmHg, p = 0.018) and, during the 2nd 24-h period, higher sleep-through SBP/DBP surges (SBP: 20.02 ± 18.17 vs 12.79 ± 12.91mmHg, p = 0.001; DBP: 12.49 ± 10.76 vs 9.64 ± 10.53, p = 0.046). Dipping patterns did not differ between groups. Patients dialyzed on the morning shift exhibited significantly higher morning BP surge compared to the other two shifts. Future studies should confirm these observations and examine the need for individualizing the choice of dialysis shift for patients with specific circadian BP profiles.