Prevalence and Clinical Characteristics of Intradialytic Hypertension in Patients on Maintenance Hemodialysis at a Tertiary Care Center

Abstract

Aims: To estimate frequency of intra-dialytic hypertension in Indian maintenance hemdialysis patients. to describe the clinical profile of patients with intra-dialyticypertension. Study Design: Observational descriptive study. Place and Duration of Study: Dialysis unit Father Muller Medical College Hospital, Mangaluru Karnataka state India from 1st august 2022 to 31st July 2023. Methodology: A minimum of 71 patients age 18 - 85 years on maintenance hemodialysis for more than 3 months previously diagnosed with hypertension - pre-dialysis blood pressure >140/90 mmhg or post-dialysis blood pressure >130/80 who are at target dry weight enrolled. weight blood pressure of each patient measured before dialysis and immediately after dialysis termination before removing dialysis access needles during six consecutive dialysis sessions. data analyzed as percentage for categorical variables and mean and standard deviation for continuous variables. proportions compared using chi-square test and means compared using student t test. all analysis done using SPSS software. Results: Prevalence of intradialytic hypertension is 59.2%. IDH occurrence is significantly associated with hemdialysis frequency [p value .03], calcium channel blocking medication use [p value.009], inter-dialysis serum potassium level [p value .04], post-dialysis mean systolic blood pressure [p value .001], post dialysis mean diastolic blood pressure [value .001] occurrence of IDH is not significantly associated with gender, type 2 diabetes mellitus, age, hem dialysis vintage, pre- dialysis weight, intra-dialysis weight loss, dry weight, post-dialysis weight, pre-dialysis mean systolic blood pressure, pre-dialysis mean diastolic blood pressure. Conclusion: Intra-dialytic hypertension results in significant morbidity mortality in maintenance hemodialysis patients. It seems multi-factorial. Interplay between dry weight, Volume overload, intra-dialysis sodium gain, intra-dialysis electrolyte disturbances, sympathetic nervous system activation, RAS renin activation, endothelial dysfunction, vessel wall stiffness, Dialysis procedure removing the dialyzable oral anti-hypertensive medication, Intravenous Erythropoietin stimulating agent ESA use and other yet unexplored factors could be operating. Long term studies on IDH in cardiovascular mortality and non access related mortality are needed.