P0160HOW TO MANAGE INTRADIALYTIC HYPERTENSION?

Abstract

Abstract Background and Aims Hypertension in subjects on long term dialysis is frequent. Intradialytic hypertension affects up to 20% of hemodialysis patients and occurs more frequently in patients who are older, have lower dry weights, are prescribed more antihypertensive medications. Elevated BP detected by home or ambulatory BP monitoring is clearly associated with shorter survival. Method We realized a cross sectional study in two hemodialysis center patients during october 2019. We compared two groups of patients: group 1 with HTA (HTA+) and the second without (HTA-). Prevalence of hypertension intra dialysis (increase in systolic BP > 15mmHg during dialysis) was determined by blood pressure recordings every thirty minutes during hemodialysis. We collect information about prescription patients (bolus dose of IV nicardipine or administration of captopril orally) after HTA inicident. We collected and analyzed datas of 1476 hemodialysis sessions for 123 patients. Results The mean age of your patients was 46 ± 26,3 years with a female predominance. The mean duration of hemodialysis was 9,8 years. The initial nephropathy was hypertensive in 14,6%. 44,7% (n=55) patients used at least one antihypertensive treatment (HTA+ group), in 72,7% calcic inhibitor. Hypertension crisis in HTA+ group was higher than HTA- group, respectively 37,9% and 4,7% (p=0,0002). Concerning HTA+ group, in 9,35% of cases patients receveid IV bolus of nicardipine, 7,9% captopril and 17,9% of cases have not receveid any antihypertensive medication. In HTA- group they receveid IV nicardipine on only 2,5% cases and no drugs in half of all cases. Patients who were older and receive erythropoietin-stimulating agents were more likely to exhibit an increase in SPB despite similar amounts of ultrafiltration in each groups. It appears HTA- group had better control of hypertension crisis in 77,5% versus 65,5% in HTA+ group, at 20minutes of crisis (p= 0,004). Administration of captopril in the both group allowed better control of hypertension 90% (HTA+ group) and 84,2%(HTA- group). Hypertension crisis was more controlled in group with high ultrafiltration rate with administration of captopril . Conclusion Use of ACE inhibitors during dialysis to manage hypertension crisis appears a great solution and confirm hypothesis of activation of the renin–angiotensin–aldosterone system. Treatment of intradialytic hypertension may include careful attention to dry weight, avoidance of dialyzable antihypertensive medications, limiting the use of high calcium dialysate, achieving adequate sodium solute removal during hemodialysis, and using medications which inhibit the rennin-angiotensin-aldosterone system or which lower endothelin 1.