Kidney Week

Abstract: PUB157

Incidence and Predictive Factors of Intradialytic Hypertension in Patients Undergoing Hemodialysis? An Observational Study from North India

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Khullar, Dinesh, Max Super Speciality Hospital Saket, New Delhi, Delhi, India

Dinesh Khullar, MBBS, MD, FASN

• Singh, Harleen, Max Super Speciality Hospital Saket, New Delhi, Delhi, India

Harleen Singh, MD

• Grover, Rahul, Max Super Speciality Hospital Saket, New Delhi, Delhi, India

Rahul Grover, MD

• Bagai, Sahil, Max Super Speciality Hospital Saket, New Delhi, Delhi, India

Sahil Bagai, MD

• Singh, Kulwant, Max Super Speciality Hospital Saket, New Delhi, Delhi, India

Kulwant Singh, MD, MBBS

• Singh, Prof Narinder Pal, Max Super Speciality Hospital Saket, New Delhi, Delhi, India

Prof Narinder Pal Singh, MD, MBA, FASN

• Kumar, Deepak, Max Super Speciality Hospital Saket, New Delhi, Delhi, India

Deepak Kumar, MD, MBBS

• Singh, Abhishek, Max Super Speciality Hospital Saket, New Delhi, Delhi, India

Abhishek Singh

• Gupta, Anish Kumar, Max Super Speciality Hospital Saket, New Delhi, Delhi, India

Anish Kumar Gupta, PharmD

Background

Cardiovascular issue associated with hemodialysis is intradialytic hypertension (IDH), affecting approximately 15% of patients. To enhance our comprehension of IDH, study sought to ascertain its incidence and identify factors that predict its development in hemodialysis patients.

Methods

An observational study was carried out in 174 patients over the age of 18 years, undergoing hemodialysis at least twice a week for at least three months. IDH was defined as systolic BP increase of ≥10 mm Hg occurring during dialysis, starting after the first hour and continuing for at least 30 minutes after the session’s completion, observed in at least 4 out of 6 successive dialysis sessions. Blood tests including CBC, and KFT were performed before dialysis. ECHO-2D was conducted at baseline. BP, pulse rate, and Mean Arterial Pressure were monitored hourly and 30 minutes post-dialysis. Four-electrode BIA device (Fresenius, Germany) utilized for assessment of hydration status. Patients were categorized into two groups - IDH-group A and non-IDH group B.

Results

The incidence of IDH was 34.5%, with half of patients being male and average age was 55.4±15 years. The non-IDH group B (65.5%) consisted of 58.7% males, with mean age of 57.3±12.8 years. The most common cause of ESKD in both groups was chronic glomerulonephritis, accounting for 55% of group A and 44.7% of group B. Hypertension (86.7%) and diabetes (48.8%) were prevalent in both groups. A negative correlation was found between IDH and BMI (r-0.16,p0.037), and hemoglobin levels (r-0.21,p0.006). IDH was positively correlated with Hydration status(r0.19,p0.011), left ventricular hypertrophy (LVH) (r0.16,p0.034), and number of antihypertensive medications (r0.3,p0.01), particularly ACE/ARB use (r0.39,p0.01). The multivariate analysis revealed that hydration status (p0.037), LVH (p0.04), and ACE/ARB use (p0.02) were independent predictors of IDH.

Conclusion

Almost one-third of patients with hemodialysis experience IDH, which is a clinically relevant phenomenon. The risk factors associated with IDH include hydration status, LVH, and the use of ACEi/ARB.