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intradialytic hypertension

Eduardo Verde, Armando Pérez de Prado, Juan M López-Gómez, Borja Quiroga, Marian Goicoechea, Ana García-Prieto, Esther Torres, Javier Reque, José Luño
BACKGROUND AND OBJECTIVES: Supraventricular arrhythmias are associated with high morbidity and mortality. Nevertheless, this condition has received little attention in patients on hemodialysis. The objective of this study was to analyze the incidence of intradialysis supraventricular arrhythmia and its long-term prognostic value. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: We designed an observational and prospective study in a cohort of patients on hemodialysis with a 10-year follow-up period...
October 3, 2016: Clinical Journal of the American Society of Nephrology: CJASN
M S Rita de Cássia Mattos, Helton P Lemes, Sebastião R Ferreira-Filho
PURPOSE: To determine the association between arterial systolic blood pressure values at the beginning and at the end of a hemodialysis (HD) session in intradialytic hypertension patients. METHODS: This study evaluated the arterial systolic blood pressure patterns in 154 chronic kidney failure patients; among these patients, 18 were identified as having intradialytic hypertension. In the patients with intradialytic hypertension, four consecutive HD sessions were analyzed in which the systolic, diastolic, mean, and pulse blood pressures were automatically determined every 30 min...
September 26, 2016: International Urology and Nephrology
Panagiotis I Georgianos, Rajiv Agarwal
Contrary to the direct, graded, and causal relationship of hypertension with cardiovascular outcomes in the general population, among dialysis patients, blood pressure (BP) recorded either predialysis or postdialysis displays a U-shaped curve with mortality. This paradoxical phenomenon of lower BP or a decline in BP over time being associated with increased mortality and higher BP being associated with a lower mortality is described as "reverse" epidemiology of hypertension, raising substantial controversy on whether BP lowering causes harms or benefits among dialysis patients...
September 22, 2016: American Journal of Hypertension
Sajith Sebastian, Christelle Filmalter, Justin Harvey, Mogamat-Yazied Chothia
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...
August 2016: Clinical Kidney Journal
Natasa Eftimovska-Otovic, Risto Grozdanovski, Borjanka Taneva, Olivera Stojceva-Taneva
INTRODUCTION: Intradialytic hypertension with a prevalence of 15% among hemodialysis patients is with unknown pathophysiology, demographic, laboratoiy and clinical characteristic of patients, and it's influence on longtenn clinical effects (cardiovascular morbidity and mortality, rate of hospitalization). The aim of the study is to present the clinical, laboratoiy and demographic characteristics of patients with intradialytic hypertension in our dialysis center. MATERIALS AND METHODS: Out of 110 hemodialysis patients, 17 patients (15,45%) had intradialytic hypertension - started at a systolic pressure greater than 140 nun Hg or had an increase in systolic pressure more than 10 mm Hg during the session, and 17 patients were nonnotensive or had a drop in blood pressure dining the dialysis...
2015: Prilozi (Makedonska Akademija Na Naukite i Umetnostite. Oddelenie za Medicinski Nauki)
Christoph Wanner, Kerstin Amann, Tetsuo Shoji
The heart and the vascular tree undergo major structural and functional changes when kidney function declines and renal replacement therapy is required. The many cardiovascular risk factors and adaptive changes the heart undergoes include left ventricular hypertrophy and dilatation with concomitant systolic and diastolic dysfunction. Myocardial fibrosis is the consequence of impaired angio-adaptation, reduced capillary angiogenesis, myocyte-capillary mismatch, and myocardial micro-arteriopathy. The vascular tree can be affected by both atherosclerosis and arteriosclerosis with both lipid rich plaques and abundant media calcification...
July 16, 2016: Lancet
Anna T Mathew, Steven Fishbane, Yoshitsugu Obi, Kamyar Kalantar-Zadeh
Residual kidney function (RKF) may confer a variety of benefits to patients on maintenance dialysis. RKF provides continuous clearance of middle molecules and protein-bound solutes. Whereas the definition of RKF varies across studies, interdialytic urine volume may emerge as a pragmatic alternative to more cumbersome calculations. RKF preservation is associated with better patient outcomes including survival and quality of life and is a clinical parameter and research focus in peritoneal dialysis. We propose the following practical considerations to preserve RKF, especially in newly transitioned (incident) hemodialysis patients: (1) periodic monitoring of RKF in hemodialysis patients through urine volume and including residual urea clearance with dialysis adequacy and outcome markers such as anemia, fluid gains, minerals and electrolytes, nutritional, status and quality of life; (2) avoidance of nephrotoxic agents such as radiocontrast dye, nonsteroidal anti-inflammatory drugs, and aminoglycosides; (3) more rigorous hypertension control and minimizing intradialytic hypotensive episodes; (4) individualizing the initial dialysis prescription with consideration of an incremental/infrequent approach to hemodialysis initiation (e...
August 2016: Kidney International
Ana Rocha
Controversy surrounds the diagnosis and treatment of intradialytic hypertension. Here, we describe the definition, epidemiology and management of intradialytic hypertension. Although this hemodialysis complication has long been recognized, only recently it was associated with increased morbidity and mortality in dialysis patients. Endothelial cell dysfunction appears to be the major mechanism underlying this blood pressure phenomenon, and the role of extracellular volume and sodium overload remains to be better defined...
September 2016: Panminerva Medica
Namrata Krishnan, Aldo J Peixoto
Hypertension is the most common complication of end-stage renal disease and chronic hemodialysis and yet, only a third of these patients have adequately controlled blood pressures. Pathogenesis of hypertension in this population is complex and multifactorial and therefore poses numerous treatment challenges. Furthermore, it is common practice among nephrologists to withhold antihypertensives prior to a hemodialysis procedure due to concerns for intradialytic hypotension (IDH). Intradialytic hypertension (ID-HTN) is an increasingly recognized phenomenon and although less common than IDH, portends poor cardiovascular prognosis as well as reflects higher hypertension burden in the dialysis population...
July 2016: Seminars in Dialysis
Catherine Hompesch, Tsung-Wei Ma, Javier A Neyra, Lindsay Ripley, Guanghua Xiao, Jula Inrig, Robert Toto, Peter N Van Buren
BACKGROUND/AIMS: Intradialytic hypertension (IH) patients have higher mortality risk than other hemodialysis patients and have been shown to have higher ambulatory blood pressure (BP). We hypothesized that interdialytic BP patterns would differ in IH patients and hypertensive hemodialysis controls. METHODS: We consecutively screened hemodialysis patients at our university-affiliated units. Based on pre and post-HD BP measurements during the prior 2 week period, we identified IH patients and demographically matched hemodialysis controls...
2016: Kidney & Blood Pressure Research
Panagiotis I Georgianos, Fani Mpoutsiouki, Erasmia Sabani, Dimitrios N Stamatiadis, Vassilios Liakopoulos, Elias V Balaskas, Pantelis E Zebekakis, Pantelis A Sarafidis
BACKGROUND: In hemodialysis patients, the intradialytic rise in blood pressure (BP) is associated with increased mortality risk. However, the mechanisms of this adverse effect are not yet elucidated. This study examined whether intradialytic rise in BP is associated with increased arterial stiffness and wave reflections, which are powerful cardiovascular risk predictors in hemodialysis. METHODS: The pattern of intradialytic hemodynamic response was evaluated in 70 prevalent hemodialysis patients, by measuring seated brachial BP before and after the mid-week dialysis session...
April 2016: International Urology and Nephrology
Peter Noel Van Buren, Jula K Inrig
BACKGROUND: Intradialytic hypertension is a condition where there is an increase in blood pressure (BP) from pre- to post-hemodialysis; this condition has been recently identified as an independent mortality risk factor in hypertensive hemodialysis patients. The mechanisms and management of intradialytic hypertension have been explored in numerous research studies over the past few years. SUMMARY: Patients with intradialytic hypertension have been found to be more chronically volume overloaded compared to other hemodialysis patients, although no causal role has been established...
2016: Blood Purification
Sylvia Kalainy, Ryan Reid, Kailash Jindal, Neesh Pannu, Branko Braam
BACKGROUND: Achievement of normal volume status is crucial in hemodialysis (HD), since both volume expansion and volume contraction have been associated with adverse outcome and events. OBJECTIVES: The objectives of this study are to assess the prevalence of fluid volume expansion and depletion and to identify the best clinical parameter or set of parameters that can predict fluid volume expansion in HD patients. DESIGN: This study is cross-sectional...
2015: Canadian Journal of Kidney Health and Disease
Magdalene M Assimon, Jennifer E Flythe
BACKGROUND: Frequent blood pressure (BP) measurements are necessary to ensure patient safety during hemodialysis treatments. Intradialytic BPs are not optimal tools for hypertension diagnosis and cardiovascular risk stratification, but they do have critical clinical and prognostic significance. We present evidence associating intradialytic BP phenomena including fall, rise and variability with adverse clinical outcomes and review related pathophysiologic mechanisms and potential management strategies...
2015: American Journal of Nephrology
Ana Rocha, Clemente Sousa, Paulo Teles, Augusto Coelho, Eva Xavier
Symptomatic intradialytic hypotension (IDH) continues to be an important complication of hemodialysis treatment. There is some evidence that besides an IDH episode, repeated episodes could represent an even more important independent risk factor for mortality in hemodialysis patients. A retrospective cross-sectional study was performed to study 18 dialysis treatments in 43 patients during 6 weeks. Relationships of IDH episodes with baseline variables were examined using a Poisson regression model (generalized linear model)...
October 2015: Journal of the American Society of Hypertension: JASH
Matthew G Denker, Debbie L Cohen
Hypertension is almost universal in end-stage renal disease (ESRD) and contributes to the substantial cardiovascular (CV) morbidity and mortality observed in these patients. The management of blood pressure (BP) in ESRD is complicated by a number of factors, including missed dialysis treatments, intradialytic changes in BP, medication removal with dialysis, and poor correlation of BPs obtained in the dialysis unit with those at home and with CV outcomes. Control of extracellular volume with ultrafiltration and dietary sodium restriction represents the principal strategy to manage hypertension in ESRD, and antihypertensive medications are subsequently added if this strategy is inadequate...
July 2015: Seminars in Dialysis
Christopher W McIntyre, David J Goldsmith
Abnormalities of cognitive function and high levels of depression incidence are characteristic of hemodialysis patients. Although previously attributed to the humoral effects of uremia, it is becoming increasingly appreciated that many elements of the overall disease state in CKD patients contribute to functional disturbances and physical brain injury. These factors range from those associated with the underlying primary diseases (cardiovascular, diabetes etc.) to those specifically associated with the requirement for dialysis (including consequences of the hemodialysis process itself)...
June 2015: Kidney International
Carlo Basile, Anna Pisano, Piero Lisi, Luigi Rossi, Carlo Lomonte, Davide Bolignano
BACKGROUND: It is the object of debate whether a low or high dialysate sodium concentration (DNa(+)) should be advocated in chronic haemodialysis patients. In this paper, we aimed at evaluating benefits and harms of different DNa(+) prescriptions through a systematic review of the available literature. METHODS: MEDLINE and CENTRAL databases were searched for studies comparing low or high DNa(+) prescriptions. Outcomes of interest were mortality, blood pressure (BP), interdialytic weight gain (IDWG), plasma sodium, hospitalizations, use of anti-hypertensive agents and intradialytic complications...
April 2016: Nephrology, Dialysis, Transplantation
Rana Gopal Singh, Shivendra Singh, Surendra Singh Rathore, Tauhidul Alam Choudhary
Hemodialysis (HD) is one of the important modalities of renal replacement therapy in acute renal failure (ARF) as well as chronic renal failure (CRF). This study was performed to evaluate the various intradialytic complications that occur during HD and their management. This is a retrospective study performed in patients who underwent conventional HD during the period of 1 January 2000 to 31 December 2011 at our center. Clinical details, various complications faced and their management were retrieved from dialysis case sheets...
January 2015: Saudi Journal of Kidney Diseases and Transplantation
Periklis Dousdampanis, Kostantina Trigka, Argiris Giannopoulos, Costas Fourtounas
Hypertension is common in chronic kidney disease patients especially in those undergoing hemodialysis (HD). Usually, blood pressure falls after the HD session but in some patients a paradoxical increase has been observed during or immediately after HD. This phenomenon is referred as intradialytic hypertension. HD patients with intradialytic hypertension or increased blood pressure during HD present higher cardiovascular (CV) morbidity and mortality rates. The underlying mechanism of intradialytic hypertension is multifactorial...
2014: Current Hypertension Reviews
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