Efficacy of Progressive Ultrafiltration in Managing Intradialytic Hypertension among Hemodialysis Patients
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Abstract
Introduction: Intra-dialytic hypertension (IDH) is a condition linked with heightened risk of adverse cardiovascular outcomes for patients on maintenance haemodialysis. Our study aims to evaluate the efficacy and tolerability of intensified ultrafiltration (UF) progressively as a therapeutic intervention for IDH and to discern its effectiveness in managing this condition.
Subjects and methods: A Prospective, descriptive study was conducted over a six-month period in the Nephrology department in Karachi, Pakistan from May 07, 2023, to November 07, 2023. Initially, one hundred participants with IDH and pre-haemodialysis blood pressure below 140 mm-Hg were included. Pre- and post-dialysis blood pressure readings were taken, with a target of one litre increase in UF rates applied over a period of two weeks. Effectiveness was evaluated post-dialysis as a systolic blood pressure drop of at least 10 mm Hg and sustained for 12 weeks.
Results: Of the 100 participants enrolled, 40 were withdrawn from the study due to intolerance to UF escalation. The mean age was 57.37 ± 8.92 years with male predominance of 79.1%. Among the remaining 60 participants, 70% showed a significant a reduction in blood pressure of at least 10mm Hg by the conclusion of their treatment sessions. Patients under the age of 60, males and diabetics had a statistically significant correlation (p = 0.0005, 0.015, 0.01 respectively).
Conclusion: A significant correlation was observed between the reduction in IDH and the use of intensified, gradual UF. To further elucidate the efficacy of progressive ultrafiltration in managing intra-dialytic hypertension among haemodialysis patients, more comprehensive research is warranted.
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Van Buren PN, Inrig JK. Mechanisms and treatment of intradialytic hypertension. Blood Purif. 2016;41:188-193. Available from: https://doi.org/10.1159/000441313 DOI: https://doi.org/10.1159/000441313
Van Buren PN, Kim C, Toto RD, Inrig JK. The prevalence of persistent intradialytic hypertension in a hemodialysis population with extended follow-up. Int J Artif Organs. 2012;35:1031-1038. Available from: https://doi.org/10.5301/ijao.5000126 DOI: https://doi.org/10.5301/ijao.5000126
Bellinghieri G, Santoro D, Mazzaglia G, Savica V. Hypertension in dialysis patients. Miner Electrolyte Metab. 1999;25:84-89. Available from: https://doi.org/10.1159/000057426 DOI: https://doi.org/10.1159/000057426
Georgianos PI, Agarwal R. Blood pressure control in conventional hemodialysis. Semin Dial. 2018;31:557-562. Available from: https://doi.org/10.1111/sdi.12741 DOI: https://doi.org/10.1111/sdi.12741
Cirit M, Akcicek F, Terzioglu E, Soydaş C, Ok E, Ozbaşli CF, et al. Paradoxical rise in blood pressure during ultrafiltration in dialysis patients. Nephrol Dial Transplant. 1995;10:1417-1420. Available from: https://pubmed.ncbi.nlm.nih.gov/8538935/ DOI: https://doi.org/10.1093/ndt/10.8.1417
Mees D. Rise in blood pressure during hemodialysis-ultrafiltration: a "paradoxical" phenomenon?. Int J Artif Organs. 1996;19:569-570. Available from: https://pubmed.ncbi.nlm.nih.gov/8946230/ DOI: https://doi.org/10.1177/039139889601901001
Jones JP, Leonard EF, Sandhu G, Winkel G, Levin NW, Cortell S. Daily ultrafiltration results in improved blood pressure control and more efficient removal of small molecules during hemodialysis. Blood Purif. 2012;34:325-331. Available from: https://doi.org/10.1159/000345334 DOI: https://doi.org/10.1159/000345334
Bacary B, Moustapha F, Niakhaleen K. SAT-225 efficacy of ultrafiltration in the management of intradialytic hypertension (IDH): a randomized clinical trial in a hemodialysis center in Dakar. Kidney Int Rep. 2020;5:96. Available from: https://doi.org/10.1016/j.ekir.2020.02.240 DOI: https://doi.org/10.1016/j.ekir.2020.02.240
Inrig JK. Intradialytic hypertension: a less-recognized cardiovascular complication of hemodialysis. Am J Kidney Dis. 2010;55:580-589. Available from: https://doi.org/10.1053/j.ajkd.2009.08.013 DOI: https://doi.org/10.1053/j.ajkd.2009.08.013
Levin NW, Kotanko P, Eckardt KU. Blood pressure in chronic kidney disease stage 5D: report from a Kidney Disease: Improving Global Outcomes controversies conference. Kidney Int. 2010;77:273-284. Available from: https://doi.org/10.1038/ki.2009.469 DOI: https://doi.org/10.1038/ki.2009.469
Losito A, De Vecchio L, Di Rosso G. Postdialysis hypertension: associated factors, patient profiles, and cardiovascular mortality. Am J Hypertens. 2016;29:684-689. Available from: https://doi.org/10.1093/ajh/hpv162 DOI: https://doi.org/10.1093/ajh/hpv162
Inrig JK, Patel UD, Toto RD. Association of blood pressure increases during hemodialysis with 2-year mortality in incident hemodialysis patients: a secondary analysis of the Dialysis Morbidity and Mortality Wave 2 study. Am J Kidney Dis. 2009;54:881-890. Available from: https://doi.org/10.1053/j.ajkd.2009.05.012 DOI: https://doi.org/10.1053/j.ajkd.2009.05.012
Yang CY, Yang WC, Lin YP. Postdialysis blood pressure rise predicts long-term outcomes in chronic hemodialysis patients: a four-year prospective observational cohort study. BMC Nephrol. 2012;13:12. Available from: https://doi.org/10.1186/1471-2369-13-12 DOI: https://doi.org/10.1186/1471-2369-13-12
Rubinger D, Backenroth R, Sapoznikov D. Sympathetic activation and baroreflex function during intradialytic hypertensive episodes. PLoS One. 2012;7:36943. Available from: https://doi.org/10.1371/journal.pone.0036943 DOI: https://doi.org/10.1371/journal.pone.0036943
Kale G, Mali M, Bhangale A, Somani J, Jeloka T. Intradialytic hypertension increases non-access related hospitalization and mortality in maintenance hemodialysis patients. Indian J Nephrol. 2020;30:85-90. Available from: https://doi.org/10.4103/ijn.IJN_153_19 DOI: https://doi.org/10.4103/ijn.IJN_153_19