Abstract: FR-PO0486
Effects of Lowering Postdialysis Weight on Intradialytic Blood Pressure in 17,000 Treatments
Session Information
- Dialysis: Hemodiafiltration, Ultrafiltration, Profiling, and Interdialytic Symptoms
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Bleyer, Heidi A., Wake Forest University School of Medicine, Winston-Salem, North Carolina, United States
- Hamilton, Kristy L, Health Systems Management, Tifton, Georgia, United States
- Bleyer, Anthony J., Wake Forest University School of Medicine, Winston-Salem, United States
Background
Prior studies have suggested that a target nadir systolic blood pressure between 100 and 150 mm Hg is associated with decreased hospitalization. The Dry-Weight Reduction in Hypertensive Hemodialysis (HD) Patients (DRIP) Trial of 100 patients showed that lowering dry weight improved blood pressure control. In this investigation, we extended these results by determining the effects of lowering post-dialysis weight in 17,000 treatments in which patients had a high systolic blood pressures (BP) (>150 mm Hg) throughout the entire previous dialysis treatment.
Methods
We performed a retrospective cohort study of 493,542 HD treatments in 1668 HD patients cared for by nephrologists at Wake Forest School of Medicine from 1/1/2018 to 12/31/2023. We identified the lowest BP attained during the treatment (nadir systolic BP (nSBP)) and post-HD weight in all treatments. Follow-up treatments with a post-weight ±0.5 kg from the prior post-weight were considered to have the same post-weight as the previous treatment.
Results
Of 493,542 treatments there were 55,875 treatments with an nSBP >150 mm Hg. Of these 55,875 treatments, 50,070 had a subsequent HD treatment within three days. Of these subsequent treatments, 11,546 (23%) resulted in a rise in post-weight, 21,011 (42%) in no change and 17,513 (35%) in a decrease in post-weight. For patients with a decreased post-weight, the mean decrease was 1.15±0.77 kg. In these patients, there was a mean decrease in nSBP of 15.8±21.7 mm Hg. Table 1 shows the nSBP range according to change in post-weight. Only 1.82% of patients with a decline in the post-weight sustained a decline in the nSBP to <100 mm Hg.
Conclusion
For patients who were hypertensive throughout a dialysis treatment, the dry weight was only lowered > 0.5 kg in 35% of subsequent treatments. Dry weight lowering in patients with high systolic blood pressures throughout dialysis is associated with a decrease in nSBP and only rarely associated with hypotension (1.82% of treatments).
Effect of Change in Post-Dialysis Weight on Nadir Systolic Blood Pressure
| Rise on post-HD weight | Same post-HD weight | Decline in post-HD weight | |
| nSBP > 150 mm Hg | 5877 (50.9%) | 9913 (47.2%) | 8367 (47.8%) |
| nSBP 100-150 mm Hg | 5428 (47.0) | 10759 (51.2%) | 8827 (50.4%) |
| nSBP <100 mm Hg | 241 (2.1%) | 339 (1.6%) | 319 (1.82%) |
p<0.05 for comparison between cells
Funding
- Clinical Revenue Support