Kidney Week

Abstract: SA-PO882

Low BMI Is Associated with Higher Risk of Frequent Intradialytic Hypertension

Session Information

• Dialysis: Cardiovascular, BP, Volume
  October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Leite, Maurilo, DaVita-Brazil, Rio De Janeiro, Brazil

Maurilo Leite,

• Pereira, Thays Cardoso mortaia, DaVita-Brazil, Rio De Janeiro, Brazil

Thays Cardoso mortaia Pereira,

• Rodrigues, Renata Martins guedes, DaVita-Brazil, Rio De Janeiro, Brazil

Renata Martins guedes Rodrigues,

• Krishnan, Mahesh, DaVita, Inc, Denver, Colorado, United States

Mahesh Krishnan,

Background

Intradialytic hypertension (IDH) has been associated with high mortality and morbidity among hemodialysis (HD) patients. Factors such as fluid overload, dialysate sodium, clearance of anti-hypertensive drugs, and an endothelin effect have all been suggested to affect IDH. However, IDH has not been uniformly characterized: studies have defined IDH as a post-HD increase in systolic arterial pressure (SAP) occurring with differing monthly frequency. In this study we examined the associations between BMI and IDH ocurring with various monthly frequencies.

Methods

We followed 217 patients who were stable on HD for at least 90 days and evaluated the number of dialysis treatments affected by IDH (defined as pre- to post-HD increase in SAP of ≥ 10 mmHg, reaching values ≥ 140/90 mmHg) over 90 days. We assessed associations of IDH frequency (% of treatments affected) with patient gender, age, race, time on HD, as well as with hospitalizations and mortality over 6 months. Patients were stratified into 5 groups based on BMI (< 18.5, 18.5 to 24.9, 25 to 29.9, 30 to 35, and > 35 kg/m²); numbers of patients experiencing IDH in at least 5% or at least 50% of treatments were assessed for each BMI group. Statistical tests applied were Chi-square and Pearson correlation.

Results

We found no significant correlation between IDH frequency and patient gender, age, or race. However, we found a positive correlation between IDH frequency and time on dialysis (r=0.17, P<0.01). No association of IDH frequency with hospitalization or mortality was observed. 78% of patients with BMI < 35 kg/m²experienced IDH during at least 5% of treatments, compared with 100% of patients with BMI > 35 kg/m². In contrast, the proportion of patients who had 50% or more of treatments affected by IDH was strongly associated with BMI < 18.5 kg/m²; RR: 3.2 (2.7-4.6).

Conclusion

Monthly frequency of IDH, observed over a period of 90 days in HD patients, was found to be slightly correlated with time on dialysis. Patients with BMI > 35 kg/m² experienced at least 1 episode of IDH during follow-up; patients with BMI < 18.5 kg/m² presented higher risk for IDH affecting ≥ 50% of HD sessions. Frequent IDH may contribute to high cardiovascular mortality and morbidity in HD patients with longer time on dialysis and lower BMI.

Funding

• Commercial Support – DaVita Inc