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Abstract: SA-OR49

Association of Calcium Channel Blocker Use with Intradialytic Hypotension

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • lefranc Torres, Armida, Brigham and Women's Hospital, Boston, Massachusetts, United States
  • McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States

Group or Team Name

  • McCausland Lab.
Background

Calcium channel blockers (CCBs) are commonly used as anti-hypertensive agents among patients receiving maintenance hemodialysis (HD). Despite this, little is known regarding the association of CCBs with intra-dialytic hypotension (IDH), an important adverse outcome that is associated with cardiovascular morbidity and mortality.

Methods

Using detailed data from kinetic modeling sessions of the Hemodialysis Study, random-effects regression models were fit to assess the association of CCB use versus not with IDH (defined as systolic blood pressure (SBP) <90 mm Hg if pre-HD SBP <160 mm Hg or <100 mm Hg if pre-HD SBP ≥160mm Hg. Models were adjusted for age, sex, race, Kt/V assignment, flux assignment, heart failure, ischemic heart disease, peripheral vascular disease, diabetes mellitus, BUN, ultrafiltration rate, access type (catheter, fistula, graft), pre-HD SBP, and other anti-hypertensive use.

Results

Data was available for 1,838 patients and 64,538 sessions; at baseline 49% of patients were prescribed CCBs. The overall frequency of IDH was 14% with a mean decline from pre- to nadir-SBP of 33 ±15 mmHg. CCB use was associated with a lower adjusted odds of IDH, compared with no use (OR 0.81; 95%CI 0.75, 0.87). The association was most pronounced for those with (OR 0.77; 95%CI 0.69, 0.86) versus without (OR 0.87; 95%CI 0.78, 0.98) a history of HF at baseline (P-interaction=0.05).

Conclusion

Among patients receiving thrice-weekly HD in the Hemodialysis study, CCB use was associated with a lower risk of developing IDH, independent of pre-HD SBP and other anti-hypertensive use. Mechanistic studies are needed to better understand the effects of CCB and other anti-hypertensives on peri-dialytic blood pressure parameters among patients receiving maintenance HD.