Abstract

Intra-dialytic hypertension, defined as an increase in blood pressure (BP) from pre- to post-hemodialysis (HD), affects 5-15% of patients receiving maintenance HD and is associated with cardiovascular and all-cause mortality. Hypervolemia is thought to be a major etiological factor, yet the association of more objective biomarkers of volume status with intra-dialytic hypertension is not well described.In a post hoc analysis of the Frequent Hemodialysis Network Daily Trial (n=234), using data from baseline, 1, 4, and 12-month visits (n=800), we used random effects regression to assess the association of bioimpedance estimates of volume (vector length) with post-HD systolic BP (continuous) and any increase in systolic BP (categorical) from pre- to post-HD. We adjusted models for randomized group, age, sex, self-reported race, Quételet (body mass) index, vascular access, HD vintage, hypertension, a history of heart failure, diabetes, residual kidney function (urea clearance), pre-HD systolic BP, ultrafiltration rate, serum-dialysate sodium gradient, and baseline values of hemoglobin, phosphate, and equilibrated Kt/V urea.The mean age of participants was 50 ±14 years, 39% were female, and 43% were Black. In adjusted models, shorter vector length (per 50 O/m) was associated with higher post-HD systolic BP (2.9 mmHg; 95%CI 1.6, 4.3) and higher odds of intra-dialytic hypertension (OR 1.66; 95%CI 1.07, 2.55). Similar patterns of association were noted with a more stringent definition of intra-dialytic hypertension (>10 mmHg increase from pre-to post-HD systolic BP), where shorter vector length (per 50 O/m) was associated with a higher odds of intra-dialytic hypertension (OR 2.17; 95%CI 0.88, 5.36).Shorter vector length, a bioimpedance-derived proxy of hypervolemia, was independently associated with higher post-HD systolic BP and risk of intra-dialytic hypertension.

View details for DOI 10.2215/CJN.0000000000000356

View details for PubMedID 37971865