Escalating Antihypertensive Medications in End-Stage Renal Disease Patients Does Not Improve Blood Pressure Control

Background: Hypertension is common findings in end-stage renal disease (ESRD) patients receiving hemodialysis, around two third among them are poorly controlled. We analyzed factors affecting blood pressure in patients undergoing regular hemodialysis.Methods:A single center cross-sectional study conducted including 65 patients receiving regular hemodialysis at hemodialysis unit Wangaya general hospital, Bali, Indonesia. Ordinal regression test was performed to analyze the relationship between factor associated with blood pressure in regular hemodialysis patients.Results: Among subjects included, 64 (98.5%) subject had hypertension and 22 (34.4%) subjects had well controlled blood pressure (<140/90 mmHg), 20 (31.3%) subjects had blood pressure between 140/90 to 160/100 mmHg and 22 (34.4%) subjects had blood pressure >160/100 mmHg. Univariate analysis showed statistically significant associated factors were higher number of antihypertensive medications (p=0.002), higher level of hemoglobin (p=0.008), hematocrit (p=0.012) and urea (p=0.041). Multivariate analysis showed higher amount of anti-hypertensive medications and year of dialysis were statistically significant associated with blood pressure in regular hemodialysis patients.Conclusions:Significant factors associated with blood pressure in regular hemodialysis patients were higher amount of anti-hypertensive medications and increased year of dialysis.

Download Full-text

The impact of kidney transplantation on 24–hour ambulatory blood pressure in end–stage renal disease patients

Journal of the American Society of Hypertension ◽

10.1016/j.jash.2015.04.001 ◽

2015 ◽

Vol 9 (6) ◽

pp. 427-434 ◽

Cited By ~ 4

Author(s):

Myung Hyun Lee ◽

Kyung Min Ko ◽

Seung Won Ahn ◽

Myoung Nam Bae ◽

Bum Soon Choi ◽

...

Keyword(s):

Blood Pressure ◽

Kidney Transplantation ◽

Renal Disease ◽

Ambulatory Blood Pressure ◽

End Stage Renal Disease ◽

Stage Renal Disease ◽

End Stage ◽

The Impact

Download Full-text

Effects of Variability in Blood Pressure, Glucose, and Cholesterol Concentrations, and Body Mass Index on End-Stage Renal Disease in the General Population of Korea

Journal of Clinical Medicine ◽

10.3390/jcm8050755 ◽

2019 ◽

Vol 8 (5) ◽

pp. 755 ◽

Cited By ~ 5

Author(s):

Mee Kyoung Kim ◽

Kyungdo Han ◽

Hun-Sung Kim ◽

Yong-Moon Park ◽

Hyuk-Sang Kwon ◽

...

Keyword(s):

Blood Pressure ◽

Body Mass Index ◽

General Population ◽

Renal Disease ◽

End Stage Renal Disease ◽

High Variability ◽

Metabolic Parameters ◽

Metabolic Parameter ◽

Stage Renal Disease ◽

End Stage

Aim: Metabolic parameters, such as blood pressure, glucose, lipid levels, and body weight, can interact with each other, and this clustering of metabolic risk factors is related to the progression to end-stage renal disease (ESRD). The effect of variability in metabolic parameters on the risk of ESRD has not been studied previously. Methods: Using nationally representative data from the Korean National Health Insurance System, 8,199,135 participants who had undergone three or more health examinations between 2005 and 2012 were included in this analysis. Intraindividual variability in systolic blood pressure (SBP), fasting blood glucose (FBG), total cholesterol (TC), and body mass index (BMI) was assessed by examining the coefficient of variation, variability independent of the mean, and average real variability. High variability was defined as the highest quartile of variability and low variability was defined as the lower three quartiles of variability. Results: Over a median (5–95%) of 7.1 (6.5–7.5) years of follow-up after the variability assessment period, 13,600 (1.7/1000 person-years) participants developed ESRD. For each metabolic parameter, an incrementally higher risk of ESRD was observed for higher variability quartiles compared with the lowest quartile. The risk of ESRD was 46% higher in the highest quartile of SBP variability, 47% higher in the highest quartile of FBG variability, 56% higher in the highest quartile of BMI variability, and 108% higher in the highest quartile of TC variability. Compared with the group with low variability for all four parameters, the group with high variability for all four parameters had a significantly higher risk for incident ESRD (hazard ratio (HR) 4.12; 95% CI 3.72–4.57). Conclusions: Variability in each metabolic parameter was an independent predictor of the development of ESRD among the general population. There was a composite effect of the variability in additional metabolic parameters on the risk of ESRD.

Download Full-text

Abstract 498: Increased Blood Pressure Variability and Baroreflex Impairment in Patients With End-stage Renal Disease Undergoing Hemodialysis

Hypertension ◽

10.1161/hyp.62.suppl_1.a498 ◽

2013 ◽

Vol 62 (suppl_1) ◽

Author(s):

Kátia B Scapini ◽

Valéria C Hong ◽

Janaína B Ferreira ◽

Sílvia B Souza ◽

Naomi V Ferreira ◽

...

Keyword(s):

Blood Pressure ◽

Renal Disease ◽

End Stage Renal Disease ◽

Blood Pressure Variability ◽

Baroreflex Sensitivity ◽

Low Frequency ◽

Stage Renal Disease ◽

End Stage ◽

Esrd Patients ◽

Alpha Index

Background: Patients with end-stage renal disease (ESRD) undergoing hemodialysis are susceptible to the development of autonomic dysfunction, which is associated with an increased risk of sudden death. Experimental and clinical evidence suggest a crucial role of autonomic dysfunction for both, the progression of renal disease and for the high rate of cardiovascular events in these patients. In the present study, we evaluated the heart rate variability (HRV), the blood pressure variability (BPV) and the baroreflex sensitivity (BRS) in ESRD patients undergoing hemodialysis and normal controls. Methods: Nine ESRD patients undergoing hemodialysis (mean age 53.4±10.2 years, 4 male) and nine age-matched healthy controls (mean age 52.8±10.2 years, 4 male) were assessed. Non−invasive curves of blood pressure (BP) were recorded continuously (Finometer ®) for 10 minutes, at rest, in the supine position. The heart rate variability (HRV) and systolic blood pressure variability (BPV) were estimated in the time and frequency domain (spectral analysis). The BRS was quantified by alpha index. Statistical analyzes were performed by Student's t test and the results were expressed as mean ± standard deviation. Results: ESRD patients presented lower HRV in time domain than healthy controls (SDNN: 25.8±10.7 vs. 44.6±11.7 ms, p<0.01; VAR NN: 768.3±607.4 vs. 2113.9±1261.6 ms 2 , p=0.01). All frequency domain analyzed indexes, i.e., total power (361.9±297.0 vs. 1227.2±696.3 ms 2 , p<0.01), high-frequency (181.8±128.7 vs. 358.7±179.8 ms 2 , p=0.047), low-frequency (55.1±44.2 vs. 444.6±389.9 ms 2 , p=0.02) and very-low-frequency (72.5±75.1 vs. 279.2±119.5 ms 2 , p<0.01) of HRV were lower in ESRD patients. The BPV was higher in ESRD patients when compared to controls (VAR PAS: 98.4±72.0 vs. 35.4±21.4 ms 2 , p=0.03) and BRS was lower in ESRD patients (alpha index: 4.34±3.05 vs. 7.56±2.50 ms/mmHg, p<0.02). Conclusion: ESRD patients undergoing hemodialysis presents reduced HRV, increase in BPV and reduced baroreflex sensitivity. These impairments may be associated with mortality in ESRD.

Download Full-text