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Abstract: TH-PO0491

Predictive Modeling of Hypertensive Burden in Patients on Hemodialysis Based on Dialytic Parameters

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Crecca, Andrew Anthony, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Cimagala, Ross Jude Gamelo, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
  • Fishbane, Steven, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hempstead, New York, United States
Background

Most patients on hemodialysis are hypertensive. Predialysis blood pressure overestimates overall hypertensive burden due to fluid accumulation between dialysis sessions while postdialysis blood pressure underestimates overall hypertensive burden due to fluid removal. Providers therefore lack accurate blood pressure information to guide treatment decisions. Our goal is to characterize and develop models to predict overall hypertensive burden using available clinical data.

Methods

Ambulatory blood pressure was monitored over a 44-hour interdialytic period in patients on hemodialysis with hypertension. Intradialytic parameter data from the previous 4 weeks, including volume removal, median intradialytic blood pressure, predialysis blood pressure, and postdialysis blood pressure, were analyzed for correlations with parameters characterizing hypertensive burden in the interdialytic period. These are preliminary results based on the first 28 subjects in an ongoing study.

Results

Subjects' mean interdialytic blood pressure was 148/80 mmHg. Means of predialysis, postdialysis, and intradialytic median systolic blood pressures from the previous 4 weeks were used to predict mean interdialytic systolic blood pressure in a linear regression model with R=0.677 [P =0.002]. Means of predialysis, postdialysis, and median intradialytic diastolic blood pressures from the previous 4 weeks were used to predict mean interdialytic diastolic blood pressure in a linear regression model with R=0.901 [P<0.001].

Conclusion

Means of predialysis, postdialysis, and median intradialytic blood pressures from the prior 4 weeks are positively correlated with mean interdialytic blood pressure. This suggests that predictive modeling using median intradialytic blood pressure could help providers more accurately estimate overall hypertensive burden to guide treatment decisions compared to the current practice of using predialysis and postdialysis blood pressures.

Funding

  • Clinical Revenue Support

Digital Object Identifier (DOI)