Abstract
Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than dialysis unit blood pressure. Therefore, the present study was aimed to assess the diagnostic performance of 24-hours ABPM vs. dialysis unit BPs for the diagnosis of ECG-LVH in steady state chronic hemodialysis black patients. Methods: From March 31 to September 30, 2018, interdialytic ABPM was performed after a mid-week hemodialysis session for 24 hours using a Spacelab 90207 ABPM monitor in the non-access arm in 45 stable chronic hemodialysis black patients (age ≥ 20 years, hemodialysis for at least 3 months and informed consent) attending 3 hemodialysis centers in Kinshasa. Ambulatory BP was recorded every 20 minutes during the day (6 AM to 10 PM) and every 30 minutes during the night (10 PM to 6 AM). ECG-LVH was defined using Cornell product criteria. ROC curve method was used to assess the performance of dialysis unit BPs vs. interdialytic 24-hours ABPM in diagnosing ECG-LVH. P 0.05 defined the level of statistical significance. Results: Whatever the method of BP measurement, all the SBP values were related to ECG-LVH with similar AUC and overlapping 95% CI; however, they were not significantly different from each other. 24-hours interdialytic ambulatory SBP (AUC 0.748; 95% CI 0.58 - 0.94) had the highest area under the curve. Conclusion: The present study showed that although all the two BP measurement methods equally detected ECG-LVH, 24-hours ABPM tended to have the highest diagnostic performance.
Highlights
Hypertension, a common clinical finding among patients with chronic kidney disease (CKD), often remains poorly controlled in maintenance hemodialysis (MHD) and is associated with an increased risk for cardiovascular (CV) events [1]
The present study was aimed to assess the diagnostic performance of 24-hours ABP measurement (ABPM) vs. dialysis unit blood pressure (BP) for the diagnosis of ECG-left ventricular hypertrophy (LVH) in steady state chronic hemodialysis black patients
The present study showed that all the two BP measurement methods detected electrocardiographic-left ventricular hypertrophy (ECG-LVH), 24-hours ABPM tended to have the highest diagnostic performance
Summary
Hypertension, a common clinical finding among patients with chronic kidney disease (CKD), often remains poorly controlled in maintenance hemodialysis (MHD) and is associated with an increased risk for cardiovascular (CV) events [1]. Accurate and reliable measurement of blood pressure (BP) in this specific group of patients is of diagnostic, prognostic and therapeutic importance [1] In this regard, the relationship between BP and CV outcomes in MHD has been reported to depend on the setting and the technique of BP measurement [1]. BP obtained outside the dialysis unit, whether obtained by ABP measurement (ABPM) or home BP, is more useful and accurate to diagnose LVH [6] It appears rationale for each setting to evaluate the relationship between inside and outside BP measurement and intermediate end-point such as LVH as well final end-points such as mortality in MHD patients. The aim of the present study was to assess the predictive value of peridialytic BPs and 24-hour ABPM for the diagnosis of eletrocardiographic (ECG)-LVH in steady state MHD patients in Kinshasa, the DRC
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