Abstract: SA-PO0361
Intradialytic Blood Pressure Dynamics Reveal Transitions into and out of Hypertensive States
Session Information
- Dialysis: Epidemiology and Facility Management
November 08, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Meigel, Felix J., Renal Research Institute, New York, New York, United States
- Casper, Sabrina, Renal Research Institute, New York, New York, United States
- Yueh, Sheng-Han, Renal Research Institute, New York, New York, United States
- Zhang, Hanjie, Renal Research Institute, New York, New York, United States
- Ho, Kevin, Fresenius Medical Care Holdings Inc, Waltham, Massachusetts, United States
- Fuertinger, Doris H., Renal Research Institute, New York, New York, United States
Background
Hypertension and hypotension during hemodialysis (HD) are linked to adverse outcomes. Systolic blood pressure (SBP) progression during HD, especially increasing SBPs in certain individuals, remains insufficiently characterized. This study examines SBP transitions during HD.
Methods
We analyzed SBP measurements from 289,846 treatments from 13,186 HD patients (median [IQR] 23 [21–24] treatments per patient), with a median interval of 20 [15–30] minutes between measurements. The cohort was 60.4% male, with a median post-HD weight of 80.0 [67.5–95.2] kg. Intra-dialytic SBPs were stratified by the minimum SBP within each 30-minute interval into five categories: <90 mmHg (hypotensive), 90–110 mmHg (normotensive–low), 110–130 mmHg (normotensive–high), 130–140 mmHg (hypertensive stage 1), and >140 mmHg (hypertensive stage 2+).
Results
SBP overall declined during treatment: the proportion of treatments >130 mmHg decreased by 22.8% pre- to post-HD. Among treatments with a pre-HD SBP >140 mmHg, 56.5% remained above this SBP threshold post-HD, while 5.3% declined to <110 mmHg. Conversely, a subset showed peri-dialytic SBP increases to >140 mmHg post-HD, with 32.7% of those with a pre-HD SBP at 130–140 mmHg, 21.4% at 110–130 mmHg, 13.9% at 90–110 mmHg, and 7.5% at <90 mmHg. Intra-dialytic SBP dynamics were highly variable in the first three hours of treatment: only 20.3% of all treatments remained within the same SBP category across the 0–180 min interval. Transitions were most frequent between adjacent SBP categories; only 2.2% transitioned directly between the <90 mmHg and >140 mmHg category. Noticeably, among treatments with a post-HD SBP >140 mmHg , 7.6% had a SBP <90 mmHg sometime during the 0–180 min interval.
Conclusion
Changes in intra-dialytic SBP transitions are both frequent and bidirectional. A noticeable fraction of treatments ending in hypertension originated from normo- or hypotensive ranges, underscoring the limitations of using static SBP categories and supporting the assessment of intra-dialytic SBP dynamics in addition to peri-dialytic changes.
Funding
- Commercial Support – Fresenius Medical Care Deutschland GmbH