Co-relation Between Calcium-Phosphorus Product and Hypertension in End-Stage Renal Disease Patients.

Faiza Anser,Ruqaya Qureshi,Kiran Nasir,Murtaza Dhrolia,Aasim Ahmad

doi:10.7759/cureus.18885

Abstract

ObjectiveIn our study, we evaluated the relation between calcium-phosphorus (Ca-P) product and various measurements of pre and post-dialysis blood pressure (BP) in hemodialysis (HD) patients.MethodsThis is a prospective, observational, cross-sectional study in which patients undergoing maintenance HD for > six months were enrolled through non-probability consecutive sampling during a six-month period from October 2020 to March 2021. Linear regression analysis was done to study the effect of the Ca-P product for each parameter of BP and regression coefficients were acquired.ResultsThere was a total of 111 patients in our study, of which 59 (53.2%) were male. The mean age was 50.1± 14.4. The most common comorbid was hypertension (98.2%). The mean HD vintage of patients was 5.7 ± 5.8 years. On linear regression analysis, the Ca-P product was strongly correlated with pre-HD diastolic BP (DBP) (0.7) and post-HD mean arterial pressure (MAP) (0.7) while a moderate correlation was present with pre (0.59) and post (0.64) HD systolic BP (SBP), post-HD diastolic BP (0.68), and pre-HD MAP (0.68). On the other hand, the Ca-P product was not correlated with pre and post-HD pulse pressure (0.06 and 0.1, respectively). When the independent effect of serum calcium (Ca), phosphorus (P), and parathyroid hormone on BP was studied, P had a significant correlation with pre and post-HD SBP, DBP, and MAP.ConclusionOur study demonstrates a significant association of the Ca-P product and an independent high P level with pre and post-dialysis SBP, DBP, and MAP while no association was found with pulse pressure.

Highlights

Hypertension (HTN) is a major risk factor for cardiovascular [1] and renal disease [2] while chronic kidney disease (CKD) is the most common cause of secondary hypertension
The Ca-P product was strongly correlated with pre-HD diastolic blood pressure (BP) (DBP) (0.7) and post-HD mean arterial pressure (MAP) (0.7) while a moderate correlation was present with pre (0.59) and post (0.64) HD systolic BP (SBP), post-HD diastolic BP (0.68), and pre-HD MAP (0.68)
Our study demonstrates a significant association of the Ca-P product and an independent high P level with pre and post-dialysis systolic blood pressure (SBP), diastolic blood pressure (DBP), and MAP while no association was found with pulse pressure

Summary

Introduction

Hypertension (HTN) is a major risk factor for cardiovascular [1] and renal disease [2] while chronic kidney disease (CKD) is the most common cause of secondary hypertension. HTN is common in CKD, with a prevalence of 59.9% in stage III while it reaches as high as 84.1% in end-stage renal disease (ESRD) [3]. After initiating hemodialysis (HD), the prevalence of HTN decreases temporarily and again increases in chronic HD patients (70-80%) [4]. Sodium and volume excess are considered the major reason for HTN in HD patients; other mechanisms, such as arterial stiffness, activation of the reninangiotensin-aldosterone, sympathetic nervous systems, endothelial dysfunction, sleep apnea, and the use of erythropoietin-stimulating agents, may be involved. Mineral metabolism disorders have been linked to calcification of vessels with resultant arterial stiffness [9,10,11] and hypertension in dialysis

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Conclusion