Abstract: TH-PO185
Overhydration Is an Independent Risk Factor for Postdialysis Hypertension and Predicts Mortality in Hemodialysis Patients
Session Information
- Hemodialysis and Frequent Dialysis - I
November 07, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Park, Hae Yeul, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
- Jung, Kwon soo, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
- Lee, Moon hyoung, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
- Choi, Hoon Young, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
- Kim, Hyunwook, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
- Lee, Jung eun, Yongin Severance Hospital, Gyeonggi-do, Korea (the Republic of)
- Kim, Hyung Jong, Bundang CHA Medical Center, CHA University, Seongnam, Gyeonggi-do, Korea (the Republic of)
- Park, Hyeong cheon, Gangnam Severance Hospital, Seoul, Korea (the Republic of)
Background
Accurate volume assessment is important for hemodialysis (HD) patients because chronic fluid overload leads to increased cardiovascular morbidity and mortality. Postdialysis hypertension (PDHYPER) has been reported to occur commonly in HD sessions but the cause of PDHYPER remains to be determined. Our aim was to ascertain the association between volume status and PDHYPER and the influence of PDHYPER on mortality in HD patients.
Methods
A cross-sectional multi-center study enrolled clinically stable HD patients. All patients underwent a bioimpedance analysis (BIA) after a midweek HD session to assess volume status. PDHYPER was defined as an increase in systolic blood pressure (SBP) of 10mmHg or more after dialysis. Delta SBP was calculated by SBP difference between before and after HD.
Results
A total of 254 prevalent HD patients (158 men and 96 women) with a mean age of 59.0±12.8 years were included in this study. Patients were divided into 2 groups according to the SBP change after dialysis: the hypertensive group (29.1%), and the non-hypertensive group (70.9%), those with less than 10mmHg or no increase in SBP. The hypertensive group showed older age (64.3±11.9 vs 56.8±12.6, p<0.001), more use of diuretics (45.9% vs 29.4%, p=0.016), higher ECW(Extracellular water)/TBW(Total body water) (0.400±0.014 vs 0.389±0.015, p<0.001), lower phase angle (4.4±1.6 vs 5.3±1.4, p<0.001), higher BNP (1034.1±1122.4 vs 519.0±758.7, p=0.029), and lower albumin (3.77±0.42 vs 3.97±0.34, p=0.01) than non-hypertensive group. In Pearson correlation, delta SBP showed a significantly positive correlation with ECW/TBW (r=+0.334, p<0.001). In multiple logistic regression analysis, ECW/TBW was the only independent risk factor affecting PDHYPER. Ultrafiltration volume, however, was not significantly associated with PDHYPER. PDHYPER was also associated with 4-year all cause mortality (30.2% vs 15.9%, p=0.017).
Conclusion
Our data demonstrated that increased ECW/TBW is a potential risk factor of PDHYPER and such PDHYPER independently predicts 4-year all cause mortality in HD patients. HD patients who experience frequent increase in postdialysis SBP should be reassessed for their volume status and target dry weights, with emphasis on increased the ECW/TBW ratio.