Ambulatory blood pressure monitoring in hemodialysis patients

BACKGROUND: Hypertension is one of the most critical risk factors for cardiovascular disease, which is the leading cause of death in hemodialysis (HD) patients. Medium cut-off (MCO) membrane increases the clearance of medium molecules, which could improve blood pressure (BP) control. This study aimed to compare the effect of MCO and high-flux hemodialysis membranes on BP assessed by ambulatory blood pressure monitoring (ABPM). METHODS: This is a pre-established secondary analysis of a 28-week, randomized, open-label crossover clinical trial...

PURPOSE: Increased myocardial T1 values on cardiovascular MRI (CMRI) have been shown to be a surrogate marker for myocardial fibrosis. The use of CMRI in patients on hemodialysis (HD) remains limited. This research aimed to explore the characteristics of native T1 values in HD patients and identify factors related to T1 values. METHODS: A total of thirty-two patients on HD and fourteen healthy controls were included in this study. All participants underwent CMRI...

Hypertension is highly prevalent in hemodialysis patients. Ambulatory-BP-monitoring(ABPM) during the 44 h interdialytic interval is recommended for hypertension diagnosis and management in these subjects. This study assessed the diagnostic accuracy of fixed 24 h ABPM recordings with 44 h BP in hemodialysis patients. 242 Greek hemodialysis patients that underwent valid 48 h ABPM(Mobil-O-Graph NG device) were included in the analysis. We used 44 h BP as reference method and tested the accuracy of the following BP metrics: 1st 24 h without HD period (20 h-1st), 1st 24 h including HD period (24 h-1st) and 2nd 24 h(24 h-2nd)...

Apparent treatment-resistant hypertension is defined as an elevated BP despite the use of ≥3 antihypertensive medications from different classes or the use of ≥4 antihypertensives regardless of BP levels. Among patients receiving maintenance hemodialysis or peritoneal dialysis, using this definition, the prevalence of apparent treatment-resistant hypertension is estimated to be between 18% and 42%. Owing to the lack of a rigorous assessment of some common causes of pseudoresistance, the burden of true resistant hypertension in the dialysis population remains unknown...

BACKGROUND: Most hemodialysis (HD) patients suffer from hypertension and have a heightened cardiovascular risk. While blood pressure (BP) control is essential to end-stage kidney disease (ESKD) patients, overly stringent control can lead to intradialytic hypotension (IDH). This study aimed to examine BP variations during and after HD to determine whether these variations correlate with IDH risk. METHODS: BP measurements during dialysis were taken from 28 ESKD patients, and ambulatory BP monitoring was applied post-dialysis...

Remarkable progress has recently been achieved in blood pressure (BP) control based on key research findings in the general population. It has been observed that maintaining BP slightly lower than previously recommended goals leads to better clinical outcomes, provided that patients can tolerate it. Previously, BP control targets for dialysis patients were extrapolated from studies conducted on the general population. However, dialysis patients are considered a distinct group with unique characteristics, which makes defining appropriate BP targets a matter of debate...

PURPOSE OF REVIEW: This narrative review aims to assess the pathophysiology, diagnosis, and treatment of resistant hypertension (RH) in end-stage kidney disease (ESKD) patients on dialysis, with a specific focus on the effect of renal denervation (RDN) on short-term and long-term blood pressure (BP) control. Additionally, we share our experience with the use of RDN in an amyloidotic patient undergoing hemodialysis with RH. RECENT FINDINGS: High BP, an important modifiable cardiovascular risk factor, is often observed in patients in ESKD, despite the administration of multiple antihypertensive medications...

In patients with end-stage renal disease (ESRD) undergoing dialysis, hypertension is common but often inadequately controlled. The prevalence of hypertension varies widely among studies because of differences in the definition of hypertension and the methods of used to measure blood pressure (BP), i.e., peri-dialysis or ambulatory BP monitoring (ABPM). Recently, ABPM has become the gold standard for diagnosing hypertension in dialysis patients. Home BP monitoring can also be a good alternative to ABPM, emphasizing BP measurement outside the hemodialysis (HD) unit...

BACKGROUND: Hypertension is highly prevalent and uncontrolled among hemodialysis patients. In Pakistan published data does not provide enough information about the management and factors associated with uncontrolled hypertension in hemodialysis patients. OBJECTIVE: This study was conducted to evaluate the factors influencing the pharmacotherapeutic management and control of hypertension in hemodialysis patients. METHODS: A prospective follow-up study was conducted on hemodialysis patients who were enrolled at study sites between 1 June 2020 and 31 December 2020...

OBJECTIVE: We used our established database to investigate predialysis blood pressure (BP) measurements at different time points. METHODS: Our study period spanned from 1 January 2019 to 31 December 2019. The different time points included: the long interdialytic interval versus the short interdialytic interval; different hemodialysis shifts. Multiple linear regression was used to explore the association between BP measurements and different time points. RESULTS: A total of 37 081 cases of hemodialysis therapies were included...

BACKGROUND: Sodium (Na) balance is unexplored in dialyzed children. We assessed a simplified sodium balance (sNaB) and its correlates in pediatric patients receiving maintenance dialysis. METHODS: Patients < 18 years old on hemodialysis (HD) or peritoneal dialysis (PD) in six European Pediatric Dialysis Working Group centers were recruited. sNaB was calculated from enteral Na, obtained by a 3-day diet diary, Na intake from medications, and 24-h urinary Na (uNa)...

BACKGROUND: Intradialytic hypotension (IDH) is one of the most important intradialytic complications and is thought to be associated with intradialytic food intake. Allowing intradialytic feeding is still unclear. This study aimed to determine the relationship between IDH and intradialytic food intake. METHODS: A nonrandomized experimental study was conducted to determine the effect of intradialytic food intake on blood pressure (BP) in hemodialysis patients. Each patient was assessed twice using an ambulatory BP monitor with and without intradialytic food intake...

Fluid overload is a common complication in patients who are on continuous ambulatory peritoneal dialysis (CAPD). Blood pressure is the traditional indicator of fluid status in these patients. However, it has poor sensitivity. Blood pressure variability (BPV) can detect fluctuations in blood pressure sooner and more accurately and be useful for the assessment of fluid volume in hemodialysis patient. However, there are limited relevant studies involving patients on CAPD. This retrospective study included 175 patients on CAPD who underwent regular assessment of the peritoneal dialysis adequacy at 2-3-month intervals at our center from January 2018 to December 2020...

BACKGROUND: Hypertension and cardiovascular disease (CVD) is the leading cause of morbidity and mortality in patients on dialysis. Blood pressure (BP) control is of paramount importance in reducing morbidity and mortality in this high-risk population, although there is no consensus on target BP. Ambulatory BP recording is considered gold standard in estimating the BP among patients on dialysis. But, ambulatory BP recording is cumbersome, not economical, and not easily available to Indian patients...

OBJECTIVE: Hypertension is the most prevalent cardiovascular risk factor in kidney transplant recipients (KTRs). Preliminary data suggest similar ambulatory blood pressure (BP) levels in KTRs and hemodialysis (HD) patients. This is the first study evaluating in comparison the full ambulatory BP profile and short-term BP variability (BPV) in KTRs versus HD patients. DESIGN AND METHOD: Two hundred four KTRs were matched (2:1 ratio) with 102 HD patients for age and gender...

OBJECTIVE: Cardiovascular disease is highly prevalent in the chronic kidney disease population. The aim of the present study was to assess data from 24 h ambulatory blood pressure (BP) monitoring and 24 h pulse wave analysis (PWA) in dialyzed children and investigate their association with left ventricular mass as a marker of increased cardiovascular risk. DESIGN AND METHOD: Children and adolescents aged 6 to 18 years, on dialysis for more than 12 months, [16 on peritoneal dialysis (PD) and 12 on hemodialysis (HD)], underwent 24 h ambulatory BP monitoring, 24 h PWA, and echocardiography...

OBJECTIVE: The optimal Blood Pressure in Hemodialysis are still unclear as to their value or measurement time and better hypotensive treatment.Some authors recommend BP < 140/90 mmHg and < 130/80 mmHg before and after HD respectively.There are an associations between predialysis systolic, diastolic and pulse pressure with all-cause mortality.Our objective is to assess the percentage of hypertensive patients in our hemodialysis unit after adjusting their dry weight and there is a difference between the pre and postdialysis blood pressure measurement...

BACKGROUND AND AIMS: Ambulatory blood pressure (BP) control is worse in men than women with chronic kidney disease or kidney transplantation. So far, no study investigated possible sex differences in the prevalence, control, and phenotypes of BP according to predialysis and 48-h ambulatory blood pressure monitoring (ABPM) in hemodialysis patients. Further, no study has evaluated the diagnostic accuracy of predialysis BP in male and female hemodialysis patients. METHOD: One hundred and twenty-nine male and 91 female hemodialysis patients that underwent 48-h ABPM were included in this analysis...

BACKGROUND: Ambulatory-BP-monitoring (ABPM) is recommended for hypertension diagnosis and management in hemodialysis patients due to its strong association with outcomes. Intradialytic and scheduled interdialytic BP recordings show agreement with ambulatory BP. This study assesses in parallel the association of pre-dialysis, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events. METHODS: We prospectively followed 242 hemodialysis patients with valid 48-h ABPMs for a median of 45...

Introduction: Hypertension leads to rapid progression of kidney disease. Hypertension (HTN) is the second most common cause for CKD after diabetes. Ambulatory blood pressure monitoring (ABPM) helps in accurate and early diagnosis of HTN along with measurements of other variables, namely nondippers, reverse dippers, hyperbaric index (HBI), percentage time elevation (PTE), and early morning surge. Methodology: After obtaining the institution ethics committee approval total 192 cases, of 12-80 years age group, who were diagnosed with CKD were included in the study...