Prevalence of Intradialysis Hypertension and the Associated Risk Factors in Patients with Hypertension and ESRD Undergoing Maintenance Hemodialysis in Three Hemodialysis Centers at Addis Ababa : A Retrospective Cross Sectional Study
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Date
2024
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Addis Ababa University
Abstract
Background: Intradialytic hypotension is an established, common, and risky
complication of hemodialysis.(1) However, hypotension is only 1 component of the
abnormal hemodynamic response to ultra filtration dialysis; the opposite
phenomenon, that is, paradoxical rise in blood pressure (BP) during or immediately
after dialysis, intradialytic hypertension is equally common and associates with
adverse cardiovascular outcomes. (1, 2) IDH affects 5-15% of patients. (1) The
pathophysiologic of IDH is complex and not fully understood, but several factors
are thought to play a role, including volume overload, RAAS activation,
endothelial dysfunction, and sympathetic over activity. (1)
Objective: the aim of the study is to assess prevalence of Intradialysis
hypertension (IDH) and the associated factors with it in three private HD centers
Secondary objective: to assess the prevalence of Intradialysis hypotension
DESIGN: Retrospective cross sectional study
Methodology: study population was all ESRD patients on maintenance
hemodialysis aged 18 and above who meet inclusion criteria and were willing to
participate in the study. Blood pressure was recorded for all patients at pre-
dialysis, 1st, 2nd, 3rd and post dialysis time for the last consecutive 6 sessions.
Blood pressure records are by the HD machine and if unexpectedly high it will be
confirmed by manual BP device (sphygmomanometer). Demographic and other
clinical data were collected from patient charts and by interviewing patients. Data
analysis was done by SPSS26. The factors associated with IDH will be researched
using a univariate logistic regression model. The significance threshold for all
statistical tests has been set at 5%. A P value of less than 0.05 is considered
significant.
Result: our study included 156 patients and analyzed 936 HD sessions over
three week’s period. Close to half of the patients (49.4%) are between 40-60 years
of age. Males accounted for 65.4%, females 34.6%. Diabetes mellitus was present
in 28.2% (44) of the patients. Majority of the participants were on MHD for more
than a year (1-2 years (30.8%), >/= 2 years (34.6%). 69.9% (109) of the
participants underwent twice per week of MHD while 27.6% (43) underwent thrice
per week of MHD. A single session of HD lasts for 3.5hrs in 75% of the cases and
the rest for 4hrs. Mean ultra-filtration rate of >/= 13ml/kg/hr was prevalent in
42.3%. The mean pre HD SBP of 140-160mmhg accounted for 41% and SBP>180
in 7.7%. 42.9 %( 67) of the participants were on dual antihypertensive.
Prevalence of IDH was 27.6 %( 43) and intradialytic hypotension was found in 648
sessions out of 936 sessions of HD (69.2%). The single factor affecting IDH was
ultra filtration rate.
Conclusion: our study showed that IDH is very prevalent in our set up and it
is more common in those with lower ultra filtration rate. The prevalence of higher
ultra filtration rate is very high close to half of patients had rate of >/= 13ml/kg/hr.
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Keywords
Intradialytic Hypertension, Intradialytic Hypotension, End Stage Renal Disease, Maintenance Hemodialysis