Association between ultrafiltration volume and intradialytic hypertension in maintenance hemodialysis
2017
Background and objectives: Increase of blood pressure during
hemodialysis (HD) is associated with adverse outcomes, while cause
of the increase in blood pressure during HD is still under debate. It
has been suggested that stimulation of RAAS by hypovolemia due to
excessive ultrafiltration (UF) during HD is the main risk factor of IDH.
We tested the hypothesis wether IDH is associated with measured UF
volume during HD, standardized BP measured (after 5 minutes of rest)
were done by nurse pre-, during dialysis and postdialysis.
Results: We found 37.5% of subject had IDH. Between group we
found predialytic systolic and diastolyc BP were similar, but average
postdialysis systolic BP was higher on IDH group. Mean of UF
volume is higher among IDH patients than controls (3.46±0.65Lvs
volume during hemodialysis.
2.37±0.77L). Using logistic regression we found significant
Methods: Forty eight stable patients who were on chronic HD were
enrolled in a case-control cohort study. Thirty patients on maintenance
HD without IDH (controls) and 18 with IDH (post HD systolic BP
increase ?10 mmHg than pre HD systolic BP on minimal four from six
consecutive HD sessions). We have done a physical examination and
past medical history review for all subjects. We also collected current
monthly laboratory results. At each subsequent dialysis treatment
from six consecutive HD sessions, we collect data of ultrafiltrasion
association between mean of UF volume and IDH (OR = 0.14 (95%
CI 0.05-0.43 , p=0.001), In IDH patients 88.9% had excessive UF (UF
? 3 L), but in control group only 13.3% had excesive UF. There was
significant and strong correlation between excessive ultrafiltration
and intradialytic hypertension (p=0.00), odds ratio 11.2 (95% CI:
2.8-43.3).
Conclusions: Intradialytic hypertension is associated with excessive
UF during hemodialysis.
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