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Kidney Week

Abstract: SA-PO509

A Clinical Study to Evaluate and Compare the Blood Pressure (BP) Measurements Taken at Peridialysis Time, at Home, and with Ambulatory BP Monitoring (ABPM) Machine in Hemodialysis Patients 

Session Information

Category: Hypertension and CVD

  • 1602 Hypertension and CVD: Clinical

Authors

  • Bohra, Vikas Kumar, Sri Balaji Action Medical Institute, New Delhi, Delhi, India
  • Aggarwal, Rajesh, Sri Balaji Action Medical Institute, New Delhi, Delhi, India
  • Bhalla, Blessy Sehgal, Sri Balaji Action Medical Institute, New Delhi, Delhi, India
  • Kurundwadkar, Mohit Mohan, Sri Balaji Action Medical Institute, New Delhi, Delhi, India

Group or Team Name

  • DrNB Nephrology.
Background

The study was conducted to find variability of BP measurements obtained at Peridialysis time & at Home with respect to ABPM which would help in better understanding of HTN & its control in HD patients.

Methods

The observational study was conducted in 50 ESRD patients undergoing HD at our centre. BP measurements were taken at baseline & at 6 months during follow up. For each case, BP measurements were taken at Pre HD, Intradialysis, Post HD at Home with calibrated digital BP machine and compared with 44 hours Ambulatory BP recorded with calibrated ABPM machine. The data was analysed both at baseline & at follow up, to find which BP taken at Pre HD, Intradialysis, Post HD & at Home showed highest agreement with the 44 hr Ambulatory BP.

Results

At baseline
44(88%) of cases at baseline were hypertensive (Average BP ≥130/80mmHg over 44 hr monitoring) based on ABPM. Average Home BP had the least difference with average BP by ABPM [SBP diff (2.88 ± 1.44), DBP diff (1.98 ± 1.17)] followed by Median Intradylitic BP{ SBP diff 3.2 ± 4.69 DBP diff 3.52 ± 3.36}. Both Pre HD & Post HD BP vary widely compared to ABPM.
On Bland Altman analysis, range of agreement was narrowest with Home BP{SBP 5.64, DBP 4.58). Peridialysis time BP {Pre HD( (SBP 11.23 to 22.49, DBP 4.15 to 15.93) Median intradialytic(SBP-5.99 to12.39,DBP-3.06 to10.10) & Post HD ( SBP-31.24 to 3.44,DBP-18.30 to 2.42)} had wide range of agreement with ABPM.
At 6 month follow up
Average Home BP had the least difference with average BP by ABPM {SBP diff (2.82 ± 1.27), DBP diff (2 ± 1.48)}. Both Pre HD & Post HD BP vary widely compared to ABPM.
On Bland Altman analysis, range of agreement was narrowest with Home BP{SBP 4.99, DBP 5.82}. Peridialysis time BP {Pre HD( (SBP 10.33 to 22.39, DBP 4.77 to 17.31) Median intradialytic(SBP-10.55 to 20.55 ,DBP-3.06 to10.10) & Post HD ( SBP-3.44 to10.92,DBP-19.08 to 4.40)} had wide range of agreement with ABPM.

Conclusion

Home BP can be an alternative to ABPM for diagnosing HTN in HD patients considering it to be more practical compared to cumbersome ABPM. At dialysis unit, Median Intradylytic BP may be an alternative to ABPM for diagnosing HTN when home BP measurements are not available. Pre HD & Post HD BP measurements should not be used to make diagnosis & treatment of HTN in HD patients.