Can predialysis hypertension prevent intradialytic hypotension in hemodialysis patients?

BACKGROUND/AIM: Intradialytic hypotension is the most common complication associated with hemodialysis, and its cause is multifactorial. However, the relationship between hypertension and intradialytic hypotension is not clear. We investigated the influence of predialysis blood pressure and antihypertensive drugs on intradialytic hypotension.

METHODS: Risk factors for intradialytic hypotension were analyzed in 111 patients undergoing regular hemodialysis treatment and had annual echocardiography performed. The correlation between the addition of antihypertensive medications and the incidence of intradialytic hypotensive episodes was studied in 21 hypertensive patients.

RESULTS: Based on multivariate logistic regression analysis, diabetes (odds ratio OR 8.18, 95% confidence interval CI 1.47-45.5; p = 0.016), interdialytic weight gain (OR 2.45, 95% CI 1.24-4.82; p = 0.010), ejection fraction (OR 0.88, 95% CI 0.81-0.95; p = 0.001), and left ventricular volume (OR 0.97, 95% CI 0.94-0.99; p = 0.013) were determined as risk factors for intradialytic hypotension. However, there was no association between predialysis blood pressure and intradialytic hypotension. After additional antihypertensive medications, the predialysis blood pressure fell from 175/85 mm Hg to 154/78 mm Hg (p < 0.0001/p < 0.0001). The mean 24-hour interdialytic blood pressure fell from 165/87 mm Hg to 147/80 mm Hg (p < 0.0001/p = 0.006). However, the frequency of hypotensive episodes was not increased (p = 0.77).

CONCLUSIONS: Diabetes, excessive interdialytic weight gain, low ejection fraction, and low left ventricular volume are independent risk factors for intradialytic hypotension. However, no correlation was found between predialysis blood pressure values or addition of antihypertensive medications and the incidence of intradialytic hypotension. Thus, hypertension may be controlled without aggravating intradialytic hypotension in hemodialysis patients.