Ravindra Attur Prabhu
1 
, Bharathi Naik
2 , Mohan V Bhojaraja
1* , Indu Ramachandra Rao
1 , Srinivas Vinayak Shenoy
1 , Shankar Prasad Nagaraju
1 , Dharshan Rangaswamy
1 1 Department of Nephrology, Kasturba Medical College, Manipal Academy Higher Education, Madhav Nagar, Manipal, Udupi, Karnataka 576104, India
2 Renal Replacement Therapy & Dialysis Technology, Manipal College of Health Professions, Manipal Academy Higher Education, Madhav Nagar, Manipal, Udupi, Karnataka 576104, India
1 Department of Nephrology, Kasturba Medical College, Manipal Academy Higher Education, Madhav Nagar, Manipal, Udupi, Karnataka 576104, India
2 Renal Replacement Therapy & Dialysis Technology, Manipal College of Health Professions, Manipal Academy Higher Education, Madhav Nagar, Manipal, Udupi, Karnataka 576104, India
1 Department of Nephrology, Kasturba Medical College, Manipal Academy Higher Education, Madhav Nagar, Manipal, Udupi, Karnataka 576104, India
2 Renal Replacement Therapy & Dialysis Technology, Manipal College of Health Professions, Manipal Academy Higher Education, Madhav Nagar, Manipal, Udupi, Karnataka 576104, India
1 Department of Nephrology, Kasturba Medical College, Manipal Academy Higher Education, Madhav Nagar, Manipal, Udupi, Karnataka 576104, India
2 Renal Replacement Therapy & Dialysis Technology, Manipal College of Health Professions, Manipal Academy Higher Education, Madhav Nagar, Manipal, Udupi, Karnataka 576104, India
Abstract
Introduction: Intradialytic hypertension (IDH) is associated with significant vascular and cardiac adverse outcomes.
Objectives: This study was performed to know the prevalence and factors predicting IDH.
Patients and Methods: A single-center cross-sectional observational study at a tertiary care hospital. After ethics committee approval and informed consent, all patients over 18 years on twice weekly hemodialysis were included, those on peritoneal dialysis and acute kidney injury excluded. Primary outcome was prevalence of IDH based on three definitions and secondary outcome was predictive factors. IDH was defined as ≥10 mm Hg surge in systolic blood pressure (SBP) between pre-and postdialysis in 4 of 6 successive sessions or >15 mm Hg rise in mean arterial pressure (MAP) between start and end of dialysis or symptomatic rise in blood pressure requiring intervention. SBP and MAP were measured on standardized monitors before, hourly and 30 minutes post dialysis.
Results: Of 136 patients, prevalence of intra-dialytic hypertension was 78/136 (57%), 33/136 (24%), 15/136 (11%) based on systolic rise, rise in MAP and symptomatic rise in BP respectively. Among those with systolic rise, diabetes mellitus (P= 0.03), undernourishment (P=0.03), inter-dialytic weight gain >3 kg (P< 0.001) and dialysis vintage > 3 years (P< 0.001) were significantly associated with IDH.
Conclusion: IDH prevalence varied from 11 to 57% with different definitions. Diabetes mellitus, under nutrition, inter-dialytic weight gain >3 kg and dialysis vintage >3 years predicted IDH.
Implication for health policy/practice/research/medical education:
This study highlights the fact that prevalence of intradialytic hypertension varies when different definitions are used and there is a requirement for a uniform definition/criterion which can be utilized by nephrologist’s across the world.
Please cite this paper as: Prabhu RA, Naik B, Bhojaraja MV, Rao IR, Shenoy SV, Nagaraju SP, Rangaswamy D. Intradialytic hypertension prevalence and predictive factors: a single centre study. J Nephropathol. 2022;11(2):e17206. DOI: 10.34172/jnp.2022.17206.