Kidney Week

Abstract: SA-PO1089

Uncontrolled Hypertension Among Patients Receiving In-Center Hemodialysis

Session Information

• Kidney Replacement Therapy and Care Delivery Innovations
  October 24, 2026 | Location: Exhibit Hall A, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Fishbane, Steven, Northwell Health Feinstein Institutes for Medical Research, Great Neck, New York, United States

Steven Fishbane, MD

• Agarwal, Rajiv, Indiana University School of Medicine, Indianapolis, Indiana, United States

Rajiv Agarwal, MD, MS, FASN

• Cimagala, Ross Jude Gamelo, Northwell Health Feinstein Institutes for Medical Research, Great Neck, New York, United States

Ross Jude Gamelo Cimagala

• Crecca, Andrew Anthony, Northwell Health Feinstein Institutes for Medical Research, Great Neck, New York, United States

Andrew Anthony Crecca

• Javor, Jon, Northwell Health Feinstein Institutes for Medical Research, Great Neck, New York, United States

Jon Javor, MA

• Liu, Angelina, Northwell Health Feinstein Institutes for Medical Research, Great Neck, New York, United States

Angelina Liu

• Cimagala, Rosela Monica G., Northwell Health Feinstein Institutes for Medical Research, Great Neck, New York, United States

Rosela Monica G. Cimagala

• Shah, Hitesh H., Northwell Health Feinstein Institutes for Medical Research, Great Neck, New York, United States

Hitesh H. Shah, MD, FASN

Background

Hypertension (HTN) is present in over 80% of End-Stage Kidney Disease patients on chronic hemodialysis (HD). Blood pressure (BP) measured in the HD center may give an inaccurate understanding of overall BP control. We used 44-hour interdialytic ambulatory BP monitoring (ABPM) to provide a broader assessment of both BP control and the predictive utility of dialysis BP measurements for determining BP control.

Methods

Patients in three outpatient HD centers (two in Nassau County, NY and one in Queens County, NY) underwent 44-hour ABPM. Monitoring started immediately after a midweek HD session and ended as the patient returned for their next treatment. Uncontrolled HTN was defined as mean 44-hour SBP > 140 mmHg or DBP > 90 mmHg. The utility of pre- and post-BP to diagnose uncontrolled HTN was assessed by calculating sensitivity and specificity.

Results

The mean 44-hour BP was 148.0±19.5/80.0±12.4 mmHg. The percentage of patients with mean SBP > 140 mmHg was 66.7% and DBP> 90 mmHg was 21.7%. Uncontrolled HTN was present in 66.7%, all driven by elevated mean SBP readings. The mean BP among patients classified as having uncontrolled HTN was 159.0±11.4/83.8±11.9 mmHg. Among the entire cohort, the percentage of SBP readings >140 mmHg was 59.5%, and DBP > 90 mmHg was 43.1%. The HTN burden was less in the first 24 hours after the HD treatment with mean SBP 146.3±18.2 and DBP 78.4±12.0 mmHg, while in hours 25-44 the mean SBP was 153.6±21.0 and DBP 82.2±14.6 mmHg (p value comparing hours 25-44 to 0-24 was SBP 0.03, and DBP 0.09). BP measured during pre or post-HD did not have sufficient utility to predict uncontrolled HTN. Pre- or post SBP > 140 mmHg had sensitivity 58.7%-76% and specificity 43.4%-47.8% with a high rate of false positive results. Pre- and post DBP > 90 mmHg had sensitivity 8.7% - 23.9% and specificity 95.6%-100%, with excessive false negative results. There were no combinations of dialysis SBP and DBP that provided sufficient utility.

Conclusion

44-hour ABPM showed that most hypertension-treated patients on chronic HD have uncontrolled HTN. BP measured pre- or post-dialysis were found to be imprecise predictors of uncontrolled HTN. Since uncontrolled HTN in HD correlates with worse cardiovascular outcomes, an increased focus on optimal BP control may be needed.

Funding

• Private Foundation Support