Key result
Recurrent intradialytic hypertension is associated with higher post-dialysis extracellular volume (ECW/TBW 0.461 vs 0.427, p=0.01) and total peripheral resistance index (3408 vs 2469, p=0.002).
Why the study?
Does recurrent intradialytic hypertension associate with differences in extracellular volume and hemodynamics compared to hypertensive hemodialysis controls?
Case-Control
Does recurrent intradialytic hypertension associate with differences in extracellular volume and hemodynamics compared to hypertensive hemodialysis controls?
Absolute Event Rate: 0.461% vs 0.427%
p-value: p=0.01
Recurrent intradialytic hypertension is driven by intradialytic surges in peripheral resistance and is associated with post-dialysis extracellular volume expansion.
Supports post-dialysis volume and resistance assessment in recurrent intradialytic hypertension; hypothesis-generating for targeted intervention trials.
BACKGROUND/AIMS: Intradialytic hypertension (IH) occurs frequently in some hemodialysis patients and increases mortality risk. We simultaneously compared pre-dialysis, post-dialysis and changes in extracellular volume and hemodynamics in recurrent IH patients and controls. METHODS: We performed a case-control study among prevalent hemodialysis patients with recurrent IH and hypertensive hemodialysis controls. We used bioimpedance spectroscopy and impedance cardiography to compare pre-dialysis, post-dialysis, and intradialytic change in total body water (TBW) and extracellular water (ECW), as well as cardiac index (CI) and total peripheral resistance index (TPRI). RESULTS: The ECW/TBW was 0.453 (0.05) pre-dialysis and 0.427 (0.04) post-dialysis in controls vs. 0.478 (0.03) and 0.461 (0.03) in IH patients (p=0.01 post-dialysis). The ECW/TBW change was -0.027 (0.03) in controls and -0.013 (0.02) in IH patients (p=0.1). In controls, pre- and post-dialysis TPRI were 3254 (994) and 2469 (529) dynes/sec/cm2/m2 vs. 2983 (747) and 3408 (980) dynes/sec/cm2/m2 in IH patients (p=0.002 post-dialysis). There were between-group differences in TPRI change (0=0.0001), but not CI (p=0.09). CONCLUSIONS: Recurrent intradialytic hypertension is associated with higher post-dialysis extracellular volume and TPRI. Intradialytic TPRI surges account for the vasoconstrictive state post-dialysis, but intradialytic fluid shifts may contribute to post-hemodialysis volume expansion.
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Buren et al. (2016) conducted a case-control in Recurrent intradialytic hypertension. Recurrent intradialytic hypertension vs. Hypertensive hemodialysis controls was evaluated on Post-dialysis extracellular water to total body water ratio (ECW/TBW) (p=0.01). Recurrent intradialytic hypertension is associated with higher post-dialysis extracellular volume (ECW/TBW 0.461 vs 0.427, p=0.01) and total peripheral resistance index (3408 vs 2469, p=0.002).
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