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Abstract: TH-PO207

Home vs. In-Center BP in Hypertensive Hemodialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Gul, Ambreen, Dialysis Clinic, Inc., Albuquerque, New Mexico, United States
  • Miskulin, Dana, Tufts Medical Center, Boston, Massachusetts, United States
  • Jiang, Huan, Dialysis Clinic, Inc., Albuquerque, New Mexico, United States
  • Paine, S., Dialysis Clinic, Inc., Albuquerque, New Mexico, United States
  • Pankratz, V. Shane, UNM Health Sciences Center, Albuquerque, New Mexico, United States
  • Harford, Antonia, Dialysis Clinic, Inc., Albuquerque, New Mexico, United States
  • Shaffi, Saeed Kamran, University of New Mexico, Albuquerque, New Mexico, United States
  • Zager, Philip, Dialysis Clinic, Inc., Albuquerque, New Mexico, United States
Background

In hemodialysis (HD) patients, home blood pressures (HBP) are stronger than dialysis unit BP as predictors of adverse outcomes. In the BID pilot study, we assessed safety and feasibility of treating hypertensive HD patients to a standardized predialysis systolic BP (SDUBP) of 110-140 mm Hg vs. 155-165 mm Hg. Participants measured HBP according to American Heart Association guidelines twice on the day after the midweek HD. We assessed left ventricular mass index (LVMI) using MRI at baseline and at the end of the 1-year intervention. The present study assessed the differences between HBP and SDUBP within individuals.

Methods

To be included patients had to have ≥ 6 pairs of standardized predialysis BPs from a midweek HD and a time-matched HBP the following day. Patients were assigned to one of 3 clusters, based on the average SDUBP to HBP differences and the variability of the difference within an individual, using cluster analysis in R.

Results

There were 97 patients with an average of 26 pairs of SDUBP and HBP who were included in the cluster analysis. This resulted in three clusters; (1) SDUBP > HBP (n=31); (2) no significant difference (n=36); and (3) HBP > SDUBP (n=30). LVMI in Cluster 3 (84.5, 95% CI 75.5, 93.6) were significantly higher than Cluster 1 (72.7, 95% CI 65.8, 79.6; p= 0.06) and 2 (71.5, 95% CI 65.3, 77.7; p=0.03). Within Cluster 3 there was no difference in LVMI by treatment arm. At baseline, the participants in Cluster 3 had higher LVMI than those in Clusters 1 and 2. Contrary to Cluster 1 and 2, systolic BP post-dialysis (151.7 mm Hg) was significantly higher than pre-dialysis (149.1 mm Hg) in Cluster 3 (p= 0.001). Variability was similar across clusters.

Conclusion

Patients in Cluster 3 (HBP higher than SDUBP) had higher LVMI at baseline and after the 12-month intervention than those in Clusters 1 and 2. Patients in Cluster 3 frequently had an increase in SBP during HD. Monitoring home BP measurements may improve care of HD patients.

Funding

  • NIDDK Support