Intradialytic hypertension in maintenance hemodialysis patients

Abstract

Objectives To study the intradialytic (RABP) and interdialytic (ERBP) behaviour of blood pressure in maintenance hemodialysis (MHD) patients (pts). Method Conventional blood pressure recording was done before, after and at half hourly intervals during each dialysis session of 4 h in 60 stable hemodialysis patients involving 898 dialysis sessions over a period of 3 months. Results ERBP was categorized as: Group A: normotensive in interdialytic period (n=9 pts), Group B: hypertensive in interdialytic period (n=41 pts), and Group C: indeterminate pattern (n=10 pts). RABP in groups A and B was subclassified as: Type X: no significant intradialytic change in BP (δ<20 mm Hg), Type Y: >20 mm Hg rise in BP in intradialytic period (↑ RABP), and Type Z: >20 mm Hg fall in BP in intradialytic period (↓ RABP). 70% of our MHD patients (41/60) arrive hypertensive predialysis at our unit. In groups A+B (n=50), 50% had Type Y behaviour, 28% patients had Type Z behaviour while 22% had Type X behaviour. Patients in Group C could not be analysed. 22% of all dialysis sessions (196/898) were complicated by >20 mm Hg rise in BP during the dialysis session. Conclusions We note an unexpectedly high incidence of intradialytic hypertension. Adverse events attributable to ↑ RABP such as worsening LVF, headache, convulsions, angina etc. can be frequently encountered during dialysis. Intradialytic hypertension appears to occur irrespective of whether the interdialytic pressure is under control or not. The causative factors for ↑ RABP need to be identified and corrected. Objectives To study the intradialytic (RABP) and interdialytic (ERBP) behaviour of blood pressure in maintenance hemodialysis (MHD) patients (pts). Method Conventional blood pressure recording was done before, after and at half hourly intervals during each dialysis session of 4 h in 60 stable hemodialysis patients involving 898 dialysis sessions over a period of 3 months. Results ERBP was categorized as: Group A: normotensive in interdialytic period (n=9 pts), Group B: hypertensive in interdialytic period (n=41 pts), and Group C: indeterminate pattern (n=10 pts). RABP in groups A and B was subclassified as: Type X: no significant intradialytic change in BP (δ<20 mm Hg), Type Y: >20 mm Hg rise in BP in intradialytic period (↑ RABP), and Type Z: >20 mm Hg fall in BP in intradialytic period (↓ RABP). 70% of our MHD patients (41/60) arrive hypertensive predialysis at our unit. In groups A+B (n=50), 50% had Type Y behaviour, 28% patients had Type Z behaviour while 22% had Type X behaviour. Patients in Group C could not be analysed. 22% of all dialysis sessions (196/898) were complicated by >20 mm Hg rise in BP during the dialysis session. Conclusions We note an unexpectedly high incidence of intradialytic hypertension. Adverse events attributable to ↑ RABP such as worsening LVF, headache, convulsions, angina etc. can be frequently encountered during dialysis. Intradialytic hypertension appears to occur irrespective of whether the interdialytic pressure is under control or not. The causative factors for ↑ RABP need to be identified and corrected.