Abstract
Background and Aims
Hypertension is highly prevalent in hemodialysis patients. Current recommendations suggest the use of ambulatory-BP-monitoring (ABPM) as the gold-standard for hypertension diagnosis and management in these subjects. This study assessed the accuracy of peridialytic, intradialytic and scheduled interdialytic recordings in diagnosing high 44-h interdialytic BP.
Method
A total of 242 hemodialysis patients that underwent valid 48-h ABPM were included in the analysis. We used ambulatory BP as reference standard and tested the accuracy of the following BP metrics: Pre- and post-dialysis, Intradialytic, Intradialytic plus pre/post-dialysis readings and Scheduled interdialytic BP (out-of-dialysis day: readings at 8:00 am, 8:00 pm or their average).
Results
44-h SBP/DBP levels had significant differences with and pre- or post-dialysis BP, but no or minor differences with any of the other BP metrics. 44-h SBP and DBP correlated strongly with Intradialytic (r=0.713/0.753, p<0.001), Intradialytic plus pre/post-dialysis (r=0.725/0.758, p<0.001) and averaged Scheduled interdialytic BP (r=0.874/0.823, p<0.001). Bland-Altman plots showed absence of systemic bias for all index metrics, but large between-method difference and wider 95% limits of agreement for pre- and post-dialysis BP compared to Intradialytic, Intradialytic plus pre/post-dialysis and averaged Scheduled interdialytic BP. In ROC-analysis for diagnosing 44-h SBP≥130mmHg, the Area-Under-the-Curve of pre-dialysis (0.723) and post-dialysis SBP (0.746) were significantly lower than that of Intradialytic (0.850), Intradialytic plus pre/post-dialysis (0.850) and Scheduled interdialytic SBP (0.917) (z-test, p<0.001 for all pairwise comparisons). The corresponding sensitivity/specificity values were 76.6%/54.5%, 78.7%/59.4%, 73.0%/81.2%, 68.1%/88.1% and 82.3%/89.1%, respectively. Similar observations were made for DBP.
Conclusion
In contrast to pre- and post-dialysis BP, the average of intradialytic, intradialytic plus pre/post-dialysis or scheduled interdialytic BP recordings show reasonable agreement with ambulatory BP and may be used for hypertension diagnosis and management in hemodialysis.
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