Ambulatory blood pressure monitoring in hemodialysis patients

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OBJECTIVES: Hypertension is highly prevalent and independently associated with adverse outcomes in patients undergoing hemodialysis. Volume overload is the main mechanism of increased blood pressure (BP) in these individuals. This study examines the long-term effects of dry-weight reduction with a standardized lung-ultrasound (US)-guided strategy on ambulatory BP in hypertensive hemodialysis patients. METHODS: This is the report of the 12-month follow-up of a randomized controlled trial in 71 clinically euvolemic, hemodialysis patients with hypertension...

INTRODUCTION: Our aim was to determine the relationship between the modality of renal replacement therapy and inflammation markers, blood pressure control and QoL. METHOD: Sixteen hemodialysis,17 peritoneal dialysis patients and 27 kidney transplant receivers (KTr) have been included in this study. Short form of 36 (SF-36) for the evaluation of QoL and ambulatory blood pressure monitoring were performed at same day. ESR, CRP, IL-6, IL-10 were measured. RESULTS: While the mean IL-10, IL-6 and CRP levels were the highest in the dialysis groups, there were no significantly differences any parameters for all groups...

RATIONALE AND OBJECTIVE: Current recommendations suggest the use of ambulatory-BP-monitoring (ABPM) as the gold-standard for hypertension diagnosis and management in hemodialysis patients. This study assesses the accuracy of peridialytic, intradialytic, and scheduled interdialytic recordings in detecting abnormally elevated 44-h interdialytic BP. STUDY DESIGN: Diagnostic test study. SETTINGS AND PARTICIPANTS: 242 Greek hemodialysis patients who successfully underwent ABPM...

This study aimed to determine which BP measurement obtained in the HD unit correlated best with home BP and ambulatory BP monitoring (ABPM). We retrospectively analyzed data from 40 patients that received maintenance HD who had available home BP and ABPM data. Dialysis unit BPs were the averages of pre-, 2hr- (2 h after starting HD), and post-HD BP during a 9-month study. Home BP was defined as the average of morning and evening home BPs. Dialysis unit BP and home BP were compared over the 9-month study period...

Heart failure (HF), hypertension, and abnormal nocturnal blood pressure dipping are highly prevalent in hemodialysis patients. Atrial fibrillation (AF) and HF might be important mediators for the association of abnormal dipping patterns with worse prognosis. Thus, the aim of this study is to investigate the association of dipping with mortality in hemodialysis patients and to assess the influence of AF and HF. In total, 525 hemodialysis patients underwent 24-hour ambulatory blood pressure monitoring. All-cause and cardiovascular mortality served as end points...

BACKGROUND: Ambulatory pulse-wave velocity (PWV), augmentation pressure, and augmentation index (AIx) are associated with increased cardiovascular events and death in hemodialysis. The intermittent nature of hemodialysis generates a distinct ambulatory pattern, with a progressive increase of augmentation pressure and AIx during the interdialytic interval. No study so far has compared the ambulatory course of central hemodynamics and PWV between peritoneal dialysis and hemodialysis patients...

BACKGROUND: Uncontrolled hypertension notwithstanding the use of at least three drugs or hypertension controlled with at least four drugs, the widely accepted definition of treatment-resistant hypertension (TRH), is considered as a common problem in the hemodialysis population. However, to date there is no estimate of the prevalence of this condition in hemodialysis patients. METHOD: We estimated the prevalence of TRH by 44-h ambulatory BP monitoring (ABPM) in 506 hemodialysis patients in 10 renal units in Europe included in the registry of the European Renal and Cardiovascular Medicine (EURECAm,), a working group of the European Association, European Dialysis and Transplantation Association (ERA EDTA)...

Background Sleep-disordered breathing (SDB) is considered a strong risk factor for hypertension in the general population. This disturbance is common in end-stage kidney disease patients on long-term hemodialysis and improves early on after renal transplantation. Whether SDB may be a risk factor for hypertension in renal transplant patients is unclear. Methods and Results We investigated the long-term evolution of simultaneous polysomnographic and 24-hour ambulatory blood pressure (BP) monitoring recordings in a cohort of 221 renal transplant patients...

Hypertension in end-stage renal disease patients is highly prevalent and poorly controlled. Data on the ambulatory blood pressure (BP) profile and BP variability (BPV) in peritoneal dialysis (PD) patients are absent. This study examined the BP profile and BPV of patients undergoing PD in comparison with hemodialysis (HD) and predialysis chronic kidney disease CKD patients. Thirty-eight PD patients were matched for age, sex, and dialysis vintage with 76 HD patients and for age and sex with 38 patients with CKD stage 2-4...

INTRODUCTION: It has not yet been clear whether intradialytic hypertension (IDHN) translates into the presence of high BP between dialysis sessions or not. In this study, we aimed to perform interdialytic ambulatory blood pressure monitoring (ABPM) in patients with IDHN to find whether high BP persists at home. METHODS: In this case-control study, ABPM was performed during a 44-hours interdialytic period in patients on maintenance hemodialysis (HD) with pre-dialysis systolic BP (SBP) above 130 mmHg...

BACKGROUND: Sudden cardiac death is the leading cause of cardiac-related death in hemodialysis patients. Hypotensive episodes in pre-, intra-, and post-dialytic periods can present serious clinical challenges that affect a patient's quality of life and prognosis. The aim of the present study was to evaluate cardiac autonomic control and arrhythmogenic risk by analyzing 24-h heart rate variability (HRV) and heart rate turbulence (HRT) in hypotensive hemodialysis patients. METHODS: A total of 79 patients on maintenance hemodialysis treatment, 39 normotensive and 40 with frequent hypotension episodes during non-dialysis periods, were included in the study...

BACKGROUND: Blood pressure (BP) and arterial stiffness are known cardiovascular risk factors in hemodialysis (HD) patients. This study examines the prognostic significance of 44-hour BP circadian rhythm and ambulatory arterial stiffness index (AASI) in this population. METHODS: A total of 80 HD patients underwent 44-hour ambulatory BP monitoring (ABPM) with a TM-2430 monitor during a standard midweek interdialytic interval and followed up for 4.5 ± 1.7 years. The end point was all-cause mortality...

OBJECTIVES: Hemodialysis patients have premature arterial stiffness, and the relationship between pulse wave velocity (PWV) and blood pressure (BP) may be different than in other hypertensives. Previous studies in such patients showed that when BP decrease is accompanied by PWV decrease the survival is improved. This study examines the prognostic role of the mean BP (MBP)-PWV association for cardiovascular outcomes and all-cause mortality in hemodialysis. METHODS: A total of 242 hemodialysis patients underwent 48-h ambulatory BP monitoring with Mobil-O-Graph-NG and were followed for 33...

AIM: To assess the incidence of blood pressure (BP) control and various phenotypes of BP by comparing the results of office and 44-hour ambulatory brachial and central BP measurement in patients with end-stage renal disease (ESRD) on program hemodialysis (HD). MATERIALS AND METHODS: In 68 patients ESRD receiving renal replacement therapy we evaluated office peridialysis BP and performed 44-hour ambu latory monitoring (ABPM) of brachial and central BP during peridialysis period using a validated oscillometric device BPLabVasotens (OOO "Petr Telegin")...

BACKGROUND: Nondipping heart rate (NHR) is a condition reported to be associated with cardiovascular events and cardiovascular mortality recently. We aimed to search whether there is difference among hypertensive patients with and without chronic kidney disease (CKD) in terms of NHR pattern and the factors associated with NHR in patients with CKD. METHODS: The study included 133 hypertensive patients with normal kidney functions, 97 hypertensive patients with predialysis CKD, and 31 hypertensive hemodialysis patients...

Background: The objective of this study was to determine the effects of strict volume control and nondipper situation on cardiovascular disease in chronic hemodialysis patients. Methods: This study is an observational and cross-sectional study including 62 patients with normotensive chronic hemodialysis using no antihypertensive drugs. A series of measurements including ambulatory blood pressure monitoring, left ventricular mass index by echocardiography, common carotid artery intima-media thickness by ultrasound, and body fluids by bioimpedance analysis were conducted for all subjects...

Increased short-term blood pressure (BP) variability is associated with adverse cardiovascular outcomes in patients with hypertension. The present study investigated the long-term prognostic significance of the short-term blood pressure variability in patients on hemodialysis. A total of 149 patients (53.0% male; mean age: 54.5±15.1 years) receiving regular hemodialysis for >6 months were enrolled. They completed a 44-hour (excluding the hemodialysis session) ambulatory BP monitoring and comprehensive hemodynamic assessments, including carotid-femoral pulse wave velocity and pressure waveform decomposition (forward and backward wave amplitude)...

BACKGROUND: Increased short-term blood pressure (BP) variability (BPV) in hemodialysis is associated with increased cardiovascular and all-cause mortality. Studies on the impact of BP-lowering interventions on BPV are scarce. This study examined the effect of dry-weight reduction with a lung ultrasound-guided strategy on short-term BPV in hemodialysis patients with hypertension. METHODS: This is a prespecified analysis of a randomized clinical trial in 71 hemodialysis patients with hypertension, assigned in a 1:1 ratio in the active group, following a strategy for dry-weight reduction guided by pre-hemodialysis lung ultrasound and the control group following standard-of-care treatment...

Approximately 85% of hemodialysis patients are hypertensive, but less than 30% achieve adequate blood pressure (BP) control. Reduction of volume overload is fundamental for BP control, but clinical criteria to estimate dry-weight are inaccurate. In the present study we examined the effect of dry-weight reduction with a lung-ultrasound-guided strategy on ambulatory BP in 71 clinically euvolemic hemodialysis patients with hypertension. Patients were equally randomized into an active group, following a strategy for dry-weight reduction guided by pre-hemodialysis lung ultrasound, and a control group with standard-of-care treatment...