The use of intradialytic bp measurements to diagnose hypertension is unknown. Hypertension occurring during the course of dialysis is an increasingly recognized finding in esrd patients treated with hemodialysis. Intradialysis hypertension is a frustrating complication among hemodialysis hd patients. Augmented cardiopulmonary baroreflex sensitivity in. Binary logistic analyses revealed that predialysis sbp, postdialysis ecwtw and lvv were independent risk factors of intradialytic hypertension. In spite of the association with clinical signs of extracellular volume expansion, in clinical practice the attempt of a dry weight was not always associated with a normalization of blood.
She was born in ethiopia and had been diagnosed with autosomal dominant polycystic kidney disease adpkd at the age of 35 and immigrated to canada at the age of 53. Probing the mechanisms of intradialytic hypertension. The median percentage of intradialytic hypertension treatments per patient was 17. The diagnosis of hypertension among hemodialysis patients by predialysis or postdialysis blood pressure bp recordings is imprecise and biased and has poor testretest reliability. A 61yearold female was being actively monitored in the hemodialysis unit for intradialytic hypertension idh. Pathophysiology and implications of intradialytic hypertension. Hypertension is a comorbidity that is present in the majority of end. An accurate assessment of dry weight is crucial in all patients on dialysis and especially those patients prone to intradialytic hypotension. Intradialytic hypertension is a marker of volume excess. Intradialytic hypertension or idh has multiple definitions but none yet has become a standard. Idhtn affects up to 15% of all hd patients, and the pathophysiologic mechanisms remain unknown. Online monitoring and convective treatment modalities.
The threshold median intradialytic bp best associated with interdialytic hypertension is 140 mmhg systolic or 90 mmhg diastolic 19. Endstage renal disease esrd patients with a paradoxical increase in blood pressure bp during hemodialysis hd, termed intradialytic hypertension idhtn, are at significantly increased risk for mortality and adverse cardiovascular events. Patients with persistent intradialytic hypertension had lower ultrafiltration rate compared to other patients 10. Intradialytic hypertension during chronic haemodialysis. When predicting idh, the auc of the roc curve was higher for ecw. Intradialytic hypertensionchronic hypertension and intradialytic hypotension. Intradialytic hypertension is present in up to 15% of hd patients and is more common in patients who are older, have lower dry weights, and are prescribed more antihypertensive medications. Pdf intradialytic hypertension idh is defined by blood pressure bp. A large observational study recently showed that intradialytic hypertension of any magnitude increased mortality risk comparable to the most severe degrees of intradialytic hypotension. Moreover, it is the increase in the blood pressure during sessions of dialysis or an increase from the baseline to the end of the session 1,2. Targeting endothelial dysfunction with carvedilol improves intradialytic and interdialytic blood pressure and reduces the frequency of intradialytic hypertension in patients on. Intradialytic hypotension and hypertension were defined as the average decrease in systolic blood pressure sbp over 1 week, as well as the frequency over 1 month of hypotension or hypertension. However, the mechanisms of these poor outcomes are poorly understood.
Intradialytic hypertension is not a rare complication of dialysis, with a prevalence of 515% among hemodialysis patients, and it seems to be associated with adverse outcomes. Intradialytic hypertension, defined as an increase in blood pressure during or immediately after hemodialysis that results in postdialysis hypertension, has long been. The effect of profiled hemodialysis on intradialytic hemodynamics when a proper sodium balance is applied. Although intradialytic hypotension occurs more often compared to intradialytic hypertension, it. The pathogenesis of intradialytic hypertension is complex and is due in part to extracellular fluid volume expansion, increased cardiac output, activation of the renin. Diagnosing hypertension by intradialytic blood pressure recordings. Donor and recipient evaluation in renal transplantation. Raising or lowering blood pressure and muscle cramps are the main barriers for dialysis. The association between intradialytic hypertension and metabolic. This phenomenontermed intradialytic hypertension ihtnis recurrent and persistent in a subset of maintenance hd patients. Intradialytic hypertension is associated with low intradialytic arterial. Intradialytic hypertension, which is defined as any of the following.
In hemodialysis patients, ambulatory bp measurements predict adverse cardiovascular outcomes better than incenter measurements. Pdf effect of isothermic dialysis on intradialytic. Intradialytic hypertension idh is defined by blood pressure bp values during and at the end of the dialysis session. Intradialytic medical definition merriamwebster medical. The pathophysiology of intradialytic hypotension and measures to reduce its frequency are discussed. The bp rise during dialysis has a complex mechanistic background and is. Bilateral renal artery stenosis as a cause of refractory. Intradialytic hypertension frequency and shortterm. A single episode of intradialytic hypertension was defined as a predialysis to postdialysis systolic bp rise 0 mm hg. Intradialytic hypertension and the association with interdialytic ambulatory blood pressure. Intradialytic hypertension is a condition where there is an increase in blood pressure bp from pre to. Management strategies of intradialytic hypertension are based on expert opinion using the pathophysiologic principles. This study was conducted to investigate the physiological changes during intradialytic hypertension.
Emerging data suggest that intradialytic hypertension is associated with poor outcomes. The aim of our study is to assess the prevalence and associated factors of intradialytic hypertension. Background and objectives increasing bp during maintenance hemodialysis or intradialytic hypertension is associated with increased morbidity and mortality. Hypertension has a high prevalence in patients undergoing chronic hemodialysis. However, the prediction of change in bp for any given individual is difficult 20. Intradialytic hypertension is defined as elevation of blood pressure to more than 10 mmhg in the postdialysis period as compared to the predialysis one. It is an important factor of morbidity and mortality in hemodialysis patients. The association between intradialytic hypertension and metabolic disorders in end stage renal disease. Carvedilol has been shown to improve endothelial cell function in vivo and to block endothelin1 release in vitro. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Predictors of intradialytic hypertension in chronic end. Intradialytic hypertension idh is emerging as an important issue in maintenance hemodialysis mhd patients.
Intradialytic hypotension is an established, common, and risky complication of hemodialysis. The prevalence of persistent intradialytic hypertension was 8 per 100 patients. The relationship between htn and cardiovascular morbidity and mortality in dialysis patients is complex. Patients with intradialytic hypertension exhibit imbalances in endothelialderived vasoregulators nitric oxide and endothelin1, indirectly suggesting endothelial cell dysfunction.
This study hypothesized that carvedilol would improve endothelial cell function and reduce the occurrence of intradialytic hypertension. A diagnostictest study was done with interdialytic ambulatory. Etiologygenetic predispositionpre existing hypertensionextracellular volume excessincreased renin angiotensin system activity possibly in the presence of increased sodium overloadincreased sympathetic activityincreased endothelin1 to nitric oxide ratiouremic toxins admablood hyperviscositycorrection of hypoxia induced vasoconstrictionincreased dialysate sodiumsecondary. Intradialytic hypertension, defined as an increase in blood pressure during or immediately after hemodialysis that results in postdialysis hypertension, has long been recognized to complicate the hemodialysis procedure, yet often is largely ignored. Intradialytic hypertension iht, defined by an increase of 10 mmhg, is a frequent but poorly understood complication of hemodialysis treatment, associated with an overrisk of mortality. Background and objectives intradialytic hypertension is associated with adverse outcomes, yet the mechanism is uncertain. Pdf intradialytic hypertension and the association with.
The association between intradialytic hypertension and. Please tell us where you read or heard it including the quote, if possible. The prevalence of persistent intradialytic hypertension in. Association between intradialytic hypertension frequency and 30day hospitalizations. Pdf diagnosing hypertension by intradialytic blood.
Diagnosing hypertension by intradialytic blood pressure. The presence of edema and hypertension has recently been shown to be a poor predictor of volume overload. Intradialytic hypertension idh increases morbidity and mortality. Mechanisms and treatment of intradialytic hypertension fulltext. The mean prehemodialysis systolic bp for the intradialytichypertension and control groups were 144.
Assessment and management of hypertension in patients on dialysis. Intradialysis hypertension in endstage renal disease. Intradialytic hypertension during chronic haemodialysis and. Intradialytic hypertension and its association with. This retrospective crosssectional study was designed to determine clinical parameters, laboratory parameters, dialysisrelated factors, and.
A total of 266 mhd patients were enrolled, included 3 50% patients with idh and 3 patients. Intradialytic htn is observed in 15% of the maintance hemodialysis patients. The beattobeat continuous heart rate, hematocrit hct changes during hd, serum levels of nitric oxide, plasma levels of catecholamine, renin, endothelin et1, cardiac output co, and peripheral. The growing problem of intradialytic hypertension nature. Diagnosing hypertension by intradialytic blood pressure recordings rajiv agarwal, tesfamariam metiku, getachew g. Intradialytic hypertension, defined as an increase in blood pressure during or immediately after hemodialysis which results in postdialysis hypertension, has long been recognized to complicate the hemodialysis procedure, yet it is often largely ignored.
The pathogenesis is unclear, but it has been suggested that. Intradialysis hypertension in endstage renal disease patients. On the other hand, dialyzate sodium may contribute to intradialytic hypertension development by enhancing interdialytic weight gain and releasing endothelialderived vasoregulators. Intradialytic hypotension may reduce the efficacy of the dialysis procedure and contributes to the excessive morbidity and mortality that is associated with hemodialysis. In hypertensive patients, intradialytic hypertension is independently associated with a 2. The prevalence of hypertension defined by either a 44hour interdialytic ambulatory bp of. The main determinants of intradialysis hypertension during dialysis. We hypothesized that patients with intradialytic hypertension have higher interdialytic ambulatory systolic bp.
Physiological changes during hemodialysis in patients with. The variability of bp during hemodialysis treatment, which is defined by either intradialytic hypotension or intradialytic hypertension, may be attributed in hemodynamic abnormalities orand in a paradoxical response to the dialysis procedure in a subset of hemodialysis patients. Median intradialytic bp can also track changes in dryweight. Patient characteristics with intradialytic hypertension. Intradialytic hypertension is a marker of volume excess intradialytic hypertension is a marker of volume excess. Pdf there is no widely accepted definition of intradialytic hypertension. Blood pressure usually declines with ultrafiltration dialysis in the majority of patients.
This study aimed to discuss potential factors related to idh and build forecasting models for postdialysis blood pressure bp in mhd patients with idh. Intradialytic hypertension and the association with interdialytic ambulatory blood pressure article pdf available in clinical journal of the american society of nephrology 67. Carvedilol reduces intradialytic hypertension frequency. We hypothesized that patients with intradialytic hypertension have higher interdialytic ambulatory systolic. However, in 1015% of the patients, blood pressure bp can increase during dialysis. While there is currently no universally accepted definition of ihtn, most authors use a peridialytic rise of systolic blood pressure sbp of. Background and objectives intradialytic hypertension may be caused by an impaired endothelial cell response to hemodialysis. The mean prehemodialysis systolic bp for the intradialytic hypertension and control groups were 144. Patients in hemodialysis installation at rsmh palembang with intradialytic hypertension are more.
1450 805 531 299 1381 834 848 1659 1163 108 1264 675 975 321 325 43 123 1660 1228 886 1351 240 576 874 1309 1006 261 829 432