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Abstract: TH-PO216

Standing Blood Pressure Differentiates True and Pseudo Intradialytic Hypertension

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Chen, Han-Cheng, University of Texas Southwestern, Dallas, Texas, United States
  • Gregg, L Parker, University of Texas Southwestern, Dallas, Texas, United States
  • Penfield, Jeffrey G., VA North Texas Health Care System, Terrell, Texas, United States
  • Lederer, Swati, VA North Texas, Dallas, Texas, United States
  • Concepcion, Michael Lopez, Dallas Veterans Hospital, Dallas, Texas, United States
  • Van Buren, Peter N., UT Southwestern, Dallas, Texas, United States
Background

Intradialytic hypertension (IH) is a blood pressure (BP) increase from pre to post-hemodialysis (HD). While IH occurs sporadically in nearly all HD patients, recurrent IH is clinically significant and associated with extracellular volume (ECV) excess, intradialytic vasoconstriction and mortality. We investigated if standing BP measurements from a single HD treatment with seated IH could distinguish patients with recurrent vs sporadic IH.

Methods

Among HD patients with increases in seated systolic BP from pre to post-HD in a single treatment, we compared ECV/weight (biompedance spectroscopy) and cardiac hemodynamics from that treatment and intradialytic BP trends in the prior 6 months between those with increases (true IH) or decreases (pseudo IH) in standing BP from pre to post-HD.

Results

There were 18 subjects with true IH and 7 with pseudo-IH with no differences in age or demographics. True IH subjects had higher post-HD ECV/weight, intradialytic TPRI increases, and more IH episodes in the past 6 months compared to pseudo IH(Table). The intradialytic BP patterns (excluding pre and post-HD seated measurements) are shown (Figure).

Conclusion

Patients with seated, but not standing, IH in a single treatment have a different physiologic phenotype than those with true-IH. The clinical significance of IH in an individual treatment can be assessed by determining the changes in standing SBP from pre to post-HD.

Comparison of Subjects with Pseudo IH and True IH
 Pseudo IH (n=7)True IH (n=18)p-value
Seated pre-HD systolic blood pressure (mmHg)146 (14)137 (14)0.6
Seated post-HD systolic blood pressure (mmHg)167 (12)155 (18)0.07
Standing pre-HD systolic blood pressure (mmHg)160 (17)134 (14)0.002
Standing post-HD systolic blood pressure (mmHg)130 (19)150 (14)0.02
Post-HD ECV/body weight (L/kg)0.23 (0.04)0.27 (0.04)0.02
Intradialytic Change in Total Peripheral Resistance Index -491 (470)577 (840)0.005
Mean change in systolic blood pressure from pre to post-HD over prior 6 months (mmHg)-10.4 (12)4.6 (8)0.005
Percentage of treatments with seated IH in prior 6 months20 (14)43 (15)0.001

Funding

  • NIDDK Support