Abstract: FR-PO1032
A Pilot Trial Targeting Home vs. Pre-Dialysis BP in Hemodialysis (HD) Patients
Session Information
- Hypertension and CVD: Clinical Outcomes, Trials
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Hypertension and CVD
- 1402 Hypertension and CVD: Clinical, Outcomes, and Trials
Authors
- Bansal, Nisha, UW, Seattle, Washington, United States
- Glidden, David V., UCSF, San Francisco, California, United States
- Mehrotra, Rajnish, UW, Seattle, Washington, United States
- Townsend, Raymond R., UPenn, Philadelphia, Pennsylvania, United States
- Larson, Hanna Lo williams, University of Washington, Seattle, Washington, United States
- Linke, Lori, Kidney Research Institute, Seattle, Washington, United States
- Palad, Farshad, UCSF, San Francisco, California, United States
- Hsu, Chi-yuan, UCSF, San Francisco, California, United States
Background
Guidelines recommend treatment of pre-dialysis blood pressure (BP) among HD patients. However, there is a U-shaped association between pre-dialysis BP and death. We hypothesize that home BP may be a better target for treatment since there is a linear relationship between out-of-dialysis unit BP and death in observational studies. To test the feasibility of this approach, we conducted a trial of treating home vs. pre-dialysis BP in HD patients.
Methods
We conducted a 4-month randomized controlled trial of 50 HD patients at two centers, targeting home systolic BP (SBP) vs. pre-dialysis SBP 140-100 mmHg. Home and pre-dialysis SBPs were obtrained every 2 weeks and adjustments in dry weight and medications were made to reach the target SBP in each group. The primary outcomes were feasibility, adherence, tolerability and safety.
Results
One in four potentially eligible patients enrolled in the study. We had enthusiastic buy-in from 10 nephrologists from 8 different dialysis units (operated by 3 dialysis providers). The mean age of participants was 56 years, 40% were women, and 74% were non-white. All enrollees successfully completed the study except one who got a kidney transplant. Adherence to obtaining home BP was 97%. In the home BP group, there was no increased frequency of high or low pre-HD BP; lower frequency of intradialytic hypotension and falls; but more fatigue and syncope(Table).
Conclusion
This pilot study shows that HD patients can successfully participate in and adhere to home BP measurement. Given that there is a U-shaped association of pre-dialysis BP (but not out-of-dialysis-unit BP) with risk of death, targeting home BP may be a promising intervention to improve outcomes in this population and should be tested in larger clinical trials.
Funding
- NIDDK Support