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Abstract: TH-PO228

Ambulatory Blood Pressure Monitoring and Other Blood Pressure Measures in the BID (Blood Pressure in Dialysis) Pilot Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Gul, Ambreen, Dialysis Clinic Inc, Albuquerque, New Mexico, United States
  • Harford, Antonia, 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
  • Shaffi, Saeed Kamran, University of New Mexico, Albuquerque, New Mexico, United States
  • Zager, Philip, Dialysis Clinic Inc, Albuquerque, New Mexico, United States
Background

Ambulatory blood pressure monitoring (ABPM) is the gold standard for diagnosis and management of hypertension. However, poor adherence limits its use in clinical practice. In the BID pilot, we used predialysis standardized dialysis unit systolic blood pressure (SDUSBP) to drive BP management. We also compared this measure to ABPM, standardized home SBP (SHSBP), intradialysis SBP (IDSBP), and postdialysis SBP (PDSBP).

Methods

The BID protocol called for a 44-hour ABPM after the mid-week dialysis at baseline and quarterly in 5 geographic hubs, SDUSBP before each dialysis, SHSBP weekly the day after the mid-week HD treatment and also IDSBP and PDSBP with each treatment. Outcomes included the quantitative differences between these measures and their ability to predict left ventricular hypertrophy (LVH) on cardiac MRI at baseline and quarter four by analyzing the area under receiver operator characteristic (ROC) curves (AUC).

Results

Ninety-four out of 95 patients and 53 out of 84 patients eligible for ABPM, had both an ABPM and cardiac MRI at baseline and in quarter 4 respectively. The differences between average daytime SBP on ABPM vs. other measures in quarter 4 were as follows 1) SDUSBP – 3.36 (95% CI -8.72, 2.00) mm Hg; 2) IDSBP 1.63 (95% CI -2.73, 5.99) mm Hg and 3) PDSBP 1.40 (95% CI -2.90, 5.71) mm Hg. Forty-four patients in quarter 4 had ABPMs in addition to SHBP measurement. Mean difference between average day SBP on ABPM vs. SHSBP was 0.35 (95% CI -5.45, 6.16) mm Hg. The AUCs used to compare the ability of the different BP measures to predict LVH are shown.

Conclusion

Although difference between daytime SBP on ABPM and SDUSBP were higher than the other measures, the differences were modest. HSBP, IDSBP and PDSBP demonstrated similar values when compared to ABPM. ABPM was the strongest and SDUSBP the weakest predictor of LVH. Dialysis units should encourage adherence with ABPM and HBP measurements.

Funding

  • NIDDK Support