Intradialytic hypertension during chronic haemodialysis and subclinical fluid overload assessed by bioimpedance spectroscopy
Date
2016-06-19
Journal Title
Journal ISSN
Volume Title
Publisher
Oxford University Press European Renal Association
Abstract
Background: Intradialytic hypertension (IDH) increases morbidity and mortality. The prevalence in South Africa is unknown.
The pathogenesis is unclear, but it has been suggested that IDH may be due to subclinical fluid overload. The objective of this
study was to determine the prevalence of IDH and to evaluate its association with fluid overload using bioimpedance
spectroscopy (BIS).
Methods: A cross-sectional study involving 190 chronic haemodialysis patients in the Western Cape province of South Africa
was conducted between January 2013 and May 2014. IDH was defined as a >10 mmHg increase in systolic blood pressure in at
least four of six prior consecutive haemodialysis sessions.
Results: The prevalence of IDH was 28.4% (n = 54). Therewas a trend towards pre-dialysis overhydration in the IDH group when
compared with controls {2.6 L [95% confidence interval (CI) 1.7–3.4] versus 1.8 L [95% CI 1.4–2.1], respectively; P = 0.06} as
measured by BIS, but no difference in mean ultrafiltration (UF) volume (2.4 versus 2.6 L; P = 0.30). A trend towards greater use of
antihypertensive drugs was noted in the IDH group [2.5 drugs (95% CI 2.15–2.87) versus 2.1 (95% CI 1.82–2.30); P = 0.05]. More
participants in the IDH group received calcium channel blockers (54 versus 36; P = 0.03).
Conclusions: The prevalence of IDH in our treatment centres is much higher than previously reported. Subclinical fluid
overload may be a major contributing factor to the mechanism of this condition. The use of BIS identifies patients who may
benefit from additional UF.
Description
CITATION: Sebastian, S., et al. 2016. Intradialytic hypertension during chronic haemodialysis and subclinical fluid overload assessed by bioimpedance spectroscopy. Clinical Kidney Journal, 9(4):636–643, doi:10.1093/ckj/sfw052.
The original publication is available at https://academic.oup.com
The original publication is available at https://academic.oup.com
Keywords
Intradialytic hypertension, Bioimpedance monitoring, Renal hypertension, Hemodialysis patients
Citation
Sebastian, S., et al. 2016. Intradialytic hypertension during chronic haemodialysis and subclinical fluid overload assessed
by bioimpedance spectroscopy. Clinical Kidney Journal, 9(4):636–643, doi:10.1093/ckj/sfw052