41. INTRADIALYTIC HYPERTENSION PROFILE IN ROUTINE HEMODIALYSIS PATIENTS: A SINGLE CENTRE EXPERIENCE
Authors: Hustrini Ni Made 
Published: May 2021

Background:

Intradialytic hypertension is a common complication occuring during hemodialysis with the prevalence of 5–15%. It is a paradoxical rise in blood pressure (BP) during or immediately after dialysis, an opposite phenomenon of hemodynamic response to ultrafiltration. Intradialytic hypertension is associated with adverse cardiovascular outcome and can predict cardiovascular mortality.

Aim of the study:

The purpose of this study was to evaluate the intradialytic hypertension profile among maintenance hemodialysis patients.

Methods:

We conducted an observational study on our routine hemodialysis patients in Dr. Cipto Mangunkusumo General Hospital, Jakarta, from 1 February to 31 May 2019. We recruited 133 patients, undergone twice weekly hemodialysis at five hours per session. Intradialytic hypertension was defined as a rise in systolic blood pressure >10 mmHg from pre to immediately post dialysis.

Results:

Among 133 subjects, the median age is 51 years old, with predominantly male (n = 68, 51.1%). Median of the dialysis vintage is 5 years and 28.6% of our patients had diabetes (n = 38). Most of our dialysis patients taking antihypertensive medications (n = 108, 81.2%) with ACE-i/ARB and CCB are the majority agents used (41.4% and 56.4%, respectively). More than half of the subjects achieved less than 5% interdialytic weight gain (IDWG) (n = 69, 51.9%) with median of IDWG is 4.91 liter.

Intradialytic hypertension was found in 33.1% (44/133) subject. We identified no significant different from those experienced intradialytic hypertensions and those who did not, in terms of age and interdialytic weight gain (IDWG) although there is a trend in younger (<60 years old) subject and those achieving IDWG less than 5% to have a lower chance from developing intradialytic hypertension (p = 0.09, 95% CI = 0.230–1.118, OR 0.507 and p = 0.158, 95% CI = 0.286–1.229, OR = 0.593, respectively). There is a higher risk experiencing intradialytic hypertension in those dialysis with higher dialysate calcium concentration (p = 0.075, 95% CI = 0.931–4.036, OR = 1.939), shorter dialysis vintage (p = 0.06, 95% CI = 0.964–4.394, OR = 2.058) and those with higher number of antihypertensive medication used (p = 0.158, 95% CI 1.454–33.696, OR = 7.0 [three agents compared to single agents]), although it is not statistically significant. There is a slightly lower mean ultrafiltration (UF) volume in those developing intradialytic hypertension compare to subject who did not (mean UF 3668 ml vs 3700 ml, p = 0.893). We found a significant different in hemoglobin concentration with a 2.5 times chance of developing intradialytic hypertension in subject who have lower hemoglobin concentration (p = 0.018, 95% CI 1.158–5.334, OR 2.486).

Conclusion:

Intradialytic hypertension is a major hemodialysis complication observed in our unit with a higher risk found in subject with lower hemoglobin concentration. Any attempt to achieving better dialysis adequacy including optimal hemoglobin level are required to lower this complication.