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Abstract: TH-PO200

Ultrafiltration Does Not Correlate with the Difference Between Pre-Dialysis and Post-Dialysis Blood Pressure

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Mejia, Christina Irene, Drexel University College of Medicine, Division of Nephrology and Hypertension, Philadelphia, Pennsylvania, United States
  • Agarwal, Neil Kumar, Drexel University College of Medicine, Division of Nephrology and Hypertension, Philadelphia, Pennsylvania, United States
  • Aggarwal, Sandeep, Drexel University College of Medicine, Division of Nephrology and Hypertension, Philadelphia, Pennsylvania, United States
  • Ahmed, Ziauddin, Drexel University College of Medicine, Division of Nephrology and Hypertension, Philadelphia, Pennsylvania, United States
  • Ullah, Rudava, Drexel University College of Medicine, Philadelphia, Pennsylvania, United States
Background

Hypervolemia contributes to blood pressure (BP) elevations in hemodialysis (HD) patients and is addressed with ultrafiltration (UF). However, high UF rates (UFR) are generally avoided as it is associated with intradialytic hypotension. It is unknown whether the amount of UF or volume removed actually correlates with the change between pre and post dialysis BPs. We hypothesize that there is an inverse correlation, with higher UF resulting in larger decreases in post HD BP.

Methods

We reviewed the records of 24 ESRD patients receiving HD in a single outpatient center in Philadelphia over a 2 month period. Patients on midodrine were excluded, and treatments with missing pre and post HD BPs and without UF were not analyzed. Using Pearson r, we correlated intradialytic weight change (pre minus post HD weight) and achieved UF rate (UFR, ml/kg/hr) with changes in systolic BP, diastolic BP and mean arterial pressure during HD (post minus pre HD SBP, DBP and MAP). Patients were further stratified into those who received UFR < vs ≥ 10 ml/kg/hr and with intradialytic weight (IDW) changes < vs ≥ 3kg.

Results

Individual intermittent HD treatments were analyzed (n=363). We found no significant correlation between IDW change and change in SBP (r= -0.024), DBP (r= -0.012) and MAP (r= -0.019). IDW change ≥ 3kg correlated better with a decrease in SBP post HD, although it did not reach statistical significance (r= -0.24, p=0.08). There was also no correlation between achieved UFR and change in SBP (r= -0.061), DBP (r= -0.021) and MAP (r= -0.04). There was still no significant correlation even in patients who received high UFRs (≥ 10 ml/kg/hr).

Conclusion

Our study showed that UFR and IDW change did not correlate with the difference in pre and post dialysis BPs. This suggests that other factors, in addition to volume, play important roles in intradialytic BP regulation and should be explored. To our knowledge, only one other smaller study looked at similar parameters and reported a significant but weak correlation between UF and change in MAP (r=0.17, p=0.045, 136 treatments) (Kovacic, et al, 2003). Larger studies are necessary.