Weekly pattern of dialysis unit blood pressure is a promising marker for prognosis evaluation in hemodialysis population

Objectives: Hypertension is the most insidious ailment in primary care with its management being a daily affair. The avail of antihypertensive medications has affirmed their efficacy in blood pressure alleviation. Yet, the methodical choice of medication with which treatment ought to commence at the precise blood pressure threshold and maintained at a target level was undiscerned. Consequently, the Eighth Joint National Committee grants an evidence-based tool, which was employed in the appraisal of professional’s adherence to joint national committee 8 guidelines.Methods: A prospective, observational study was governed. Aggregate patients with hypertension with/without diabetes mellitus (DM) and/ or chronic kidney failure admitted in general medicine and the dialysis unit of the tertiary health care hospital, for 4 months were enrolled. The rationality of antihypertensive medications and target blood pressure was noted.Results: Patients matriculated to 125, 90 males and 35 females. Average age perceived was between 51 and 60 years, with the length of stay 14.39 (standard deviation [SD]±1.52) and 9.3 (SD±0.46) days in the respective unit. The gross medication endorsed represents 1085 medications, incorporating 337 antihypertensive medications. The optimal choice of an antihypertensive medicine was clonidine and amlodipine. Adherence in the populace with lone hypertension was cent percent, trailed by hypertension with DM 82.35% and minimal in hypertension with chronic kidney disease.Conclusion: 86-medication compiled adherence to the guidelines (25.52%). Rationality of medication depicts 25.6% were rational and 73.6% distinguish as non-rational, amid a demise of a sole victim. A significant high-grade defiance of health-care practitioners to the Eighth Joint National Committee guidelines was evidenced from our study.

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Safely reducing haemodialysis frequency during the COVID-19 pandemic

10.21203/rs.3.rs-41399/v1 ◽

2020 ◽

Author(s):

Michelle da Silva Lodge ◽

Thilini Abeygunaratne ◽

Helen Alderson ◽

Ibrahim Ali ◽

Nina Brown ◽

...

Keyword(s):

Blood Pressure ◽

Sodium Bicarbonate ◽

Systolic Blood Pressure ◽

Serum Potassium ◽

Fluid Overload ◽

Dietary Advice ◽

Dialysis Patients ◽

Short Term ◽

Dialysis Unit ◽

Patient Request

Abstract Background: Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients.Methods: Dialysis unit nephrologists identified 166 suitable patients (38.4% of our HD population) to temporarily convert to twice-weekly haemodialysis immediately prior to the peak of the COVID-19 pandemic in our area. Changes in pre-dialysis weight, systolic blood pressure (SBP) and biochemistry were recorded weekly throughout the 4-week project. Hyperkalaemic patients (serum potassium > 6.0mmol/L) were treated with a potassium binder, sodium bicarbonate and received responsive dietary advice.Results: There were 12 deaths (5 due to COVID-19) in the HD population, 6 of which were in the twice weekly HD group; no deaths were associated with change of dialysis protocol. A further 19 patients were either hospitalised and/or developed COVID-19 and thus transferred back to thrice weekly dialysis as per protocol. Of 141 eligible patients 113 (80.1%) were still receiving twice-weekly HD by the end of the 4-week project. Indications for transfer back to thrice weekly were; fluid overload (19), persistent hyperkalaemia (4), patient request (4) and compliance (1). There were statistically significant increases in SBP and pre-dialysis potassium during the project. Conclusions: Short term conversion of a large but selected HD population to twice-weekly dialysis sessions was possible and safe. This approach could help mitigate COVID-19 transmission amongst dialysis patients in centres with similar organisational pressures.

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Seasonal variation of blood pressure in maintenance hemodialysis

Sao Paulo Medical Journal ◽

10.1590/s1516-31801998000400006 ◽

1998 ◽

Vol 116 (4) ◽

pp. 1774-1777 ◽

Cited By ~ 2

Author(s):

Manuel Carlos Martins de Castro ◽

Décio Mion Jr. ◽

Marcello Marcondes ◽

Emil Sabbaga

Keyword(s):

Blood Pressure ◽

Renal Failure ◽

Seasonal Variation ◽

Chronic Renal Failure ◽

Ambient Temperature ◽

Sao Paulo ◽

São Paulo ◽

Dialysis Unit ◽

Arterial Blood ◽

The Impact

CONTEXT: Seasonal variation in arterial blood pressure has been reported in studies with hypertensive and normotensive subjects. However, the influence of seasonal change on blood pressure of hemodialysis patients has not been reported. OBJECTIVE: To investigate the seasonal variation of blood pressure in Brazil, a tropical country, in patients on hemodialysis. DESIGN: Prospective, cohort study. SETTING: Dialysis unit of a tertiary medical center (a teaching hospital of the University of São Paulo School of Medicine, São Paulo). PATIENTS: Sixteen patients with chronic renal failure undergoing hemodialysis. OUTCOMES: Blood pressure, body weight, and ambient temperature were evaluated during 6 hemodialysis sessions carried out on 13 days during the four seasons. RESULTS: The diastolic blood pressure was lower in summer than in fall and winter (95 ± 8 vs 107 ± 10 and 101 ± 10 mmHg, respectively; p < 0.05). The same was observed with mean blood pressure (116 ± 8 vs 130 ± 11 and 124 ± 9 mmHg, respectively; p < 0.01). On the other hand, the ambient temperature was higher in summer than in fall and winter (23.0 ± 1.6 vs 19.5 ± 3.0 and 15.8 ± 1.9 ºC, respectively; p < 0.01). CONCLUSIONS: We concluded that for patients with chronic renal failure the blood pressure has a seasonal variation with higher pressures in fall and winter than in summer. Thus, further studies are needed to elucidate the impact of this observation on the adjustment of antihypertensive treatment and on morbidity and mortality in maintenance dialysis patients.

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Safely reducing haemodialysis frequency during the COVID-19 pandemic

BMC Nephrology ◽

10.1186/s12882-020-02172-2 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Michelle Da Silva Lodge ◽

Thilini Abeygunaratne ◽

Helen Alderson ◽

Ibrahim Ali ◽

Nina Brown ◽

...

Keyword(s):

Blood Pressure ◽

Sodium Bicarbonate ◽

Systolic Blood Pressure ◽

Serum Potassium ◽

Fluid Overload ◽

Dietary Advice ◽

Dialysis Patients ◽

Short Term ◽

Dialysis Unit ◽

Patient Request

Abstract Background Patients undergoing haemodialysis (HD) are at higher risk of developing worse outcomes if they contract COVID-19. In our renal service we reduced HD frequency from thrice to twice-weekly in selected patients with the primary aim of reducing COVID 19 exposure and transmission between HD patients. Methods Dialysis unit nephrologists identified 166 suitable patients (38.4% of our HD population) to temporarily convert to twice-weekly haemodialysis immediately prior to the peak of the COVID-19 pandemic in our area. Changes in pre-dialysis weight, systolic blood pressure (SBP) and biochemistry were recorded weekly throughout the 4-week project. Hyperkalaemic patients (serum potassium > 6.0 mmol/L) were treated with a potassium binder, sodium bicarbonate and received responsive dietary advice. Results There were 12 deaths (5 due to COVID-19) in the HD population, 6 of which were in the twice weekly HD group; no deaths were definitively associated with change of dialysis protocol. A further 19 patients were either hospitalised and/or developed COVID-19 and thus transferred back to thrice weekly dialysis as per protocol. 113 (68.1%) were still receiving twice-weekly HD by the end of the 4-week project. Indications for transfer back to thrice weekly were; fluid overload (19), persistent hyperkalaemia (4), patient request (4) and compliance (1). There were statistically significant increases in SBP and pre-dialysis potassium during the project. Conclusions Short term conversion of a large but selected HD population to twice-weekly dialysis sessions was possible and safe. This approach could help mitigate COVID-19 transmission amongst dialysis patients in centres with similar organisational pressures.

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Attitudes Towards Plant-Based Eating and Self Reported Vegetable Intake in Inner-City Kidney Patients: Relationship to BMI and Blood Pressure

Current Developments in Nutrition ◽

10.1093/cdn/nzaa046_059 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 559-559

Author(s):

Ahmad Saleh ◽

Kingsley Cruickshank ◽

Takisha Morancy ◽

Giaynel Cordero ◽

Nicholas Baglieri ◽

...

Keyword(s):

Blood Pressure ◽

Dietary Habits ◽

Vegetable Intake ◽

Daily Basis ◽

Multiple Choice Questions ◽

Chi Square ◽

Convenience Sample ◽

Dialysis Unit ◽

Face To Face ◽

Funding Sources

Abstract Objectives A Plant-Based Eating (PBE) dietary pattern is reportedly beneficial for pts with kidney disease but attitudes of CKD/ESKD patients regarding plant-based eating and dietary habits have been rarely reported. Methods A face-to-face survey was conducted in a random convenience sample of people attending CKD clinic (15), Transplant clinic (12), and the Dialysis Unit (4). Pts were given multiple choice questions assessing their attitudes and understanding of plant-based eating and asked to estimate daily vegetable intake. No difference was noted among clinics so data were analyzed together. Comparisons are by t-test unless noted. Results Mean age was 54.7 ± 1.7 yrs with 16 (53%) men, 25 (80%)Black, 12 (40%) had an income < $20 K, with 10 (33%) between $20 K and 40 K. 10 (33%) were employed. 64.5% (20) were interested in learning more about PBE; 35% had never heard of PBE. 22(71%) reported that they consume animal protein 1–3x daily or more. 20 (57%) reported that they consume plant-based protein less than once a day or never. Pts who did not eat vegetables regularly had a higher BMI than those who ate plants more frequently (30.9 ± 1.86 vs 26.3 ± 0.96, P < 0.05), and higher systolic and diastolic BP (144.3 ± 5.9 vs 126 ± 5.2, P < 0.05 and 77.9 ± 3.5 vs 66.3 ± 4.1, P = 0.019) and were less likely to take herbal or non-vitamin supplements (1% vs 54%, P = 0.007 by Chi square). As regards beliefs about PBE, 46.4% believe it would be difficult to find things to eat at restaurants, 51.7% thought it would be difficult to buy food or groceries on a budget, 46.4% thought they could not get all the protein they need from plant-based foods without eating animal meat or products and 40.7% thought it would be hard to get all the vitamins and nutrients and 63.1% thought it would be easy to find recipes that taste good. Conclusions In our population: 1. The majority of pts were interested in learning about PBE and had heard of it. 2. The majority ate few to no vegetables on a daily basis. 3. Possible obstacles to introducing PBE are common misconceptions including difficulty of affording food, getting enough protein and finding something to eat when eating out. 4. Intensive educational programs targeted towards our population should be developed as pts who ate more vegetables had lower BMI and both systolic and diastolic blood pressure and in general PBE has been shown to be beneficial for pts with CKD/ESKD. Funding Sources None.

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Dialysis unit blood pressure two hours after hemodialysis is useful for predicting home blood pressure and ambulatory blood pressure in maintenance hemodialysis patients

Therapeutic Apheresis and Dialysis ◽

10.1111/1744-9987.13648 ◽

2021 ◽

Author(s):

Hye Yun Jeong ◽

Hyo Jin Kim ◽

Miyeun Han ◽

Eun Young Seong ◽

Sang Heon Song

Keyword(s):

Blood Pressure ◽

Ambulatory Blood Pressure ◽

Hemodialysis Patients ◽

Home Blood Pressure ◽

Maintenance Hemodialysis ◽

Dialysis Unit ◽

Maintenance Hemodialysis Patients

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Which dialysis unit blood pressure is the most accurate for predicting home blood pressure in patients undergoing hemodialysis?

The Korean Journal of Internal Medicine ◽

10.3904/kjim.2015.278 ◽

2017 ◽

Vol 32 (1) ◽

pp. 117-124

Author(s):

In-Cheol Yoon ◽

Hye-Min Choi ◽

Dong-Jin Oh

Keyword(s):

Blood Pressure ◽

Home Blood Pressure ◽

Dialysis Unit

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Abstract P632: The Blood Pressure in Dialysis (BID) Pilot Study

Hypertension ◽

10.1161/hyp.66.suppl_1.p632 ◽

2015 ◽

Vol 66 (suppl_1) ◽

Author(s):

Philip G Zager ◽

Dana Miskulin ◽

Jennifer Gassman ◽

David Ploth ◽

Manisha Jhamb ◽

...

Keyword(s):

Blood Pressure ◽

Cardiac Mri ◽

Blood Pressure Monitoring ◽

Baseline Period ◽

Full Scale ◽

Drop Out ◽

Intradialytic Hypotension ◽

Dialysis Unit ◽

Interdialytic Weight Gain ◽

The Difference

Background: The optimal blood pressure (BP) target for hypertensive hemodialysis (HD) patients is unknown. Current KDOQI guidelines have been extrapolated from data in the general population. The BID pilot, funded by NIDDK and DCI, is the first trial to randomize hypertensive HD patients to intensive (110-140 mm Hg) vs. usual (155-165 mm Hg) control of systolic blood pressure (SBP). The study’s goal is to assess the feasibility of conducting a full-scale trial. Methods: BID consortium consists of 5 clinical centers, a cardiac MRI reading center and a data coordinating center. Standardized predialysis SBP, measured in the dialysis unit in accord with AHA recommendations (SDUSBP), guide therapy. To be eligible for randomization patients needed a 2-week running mean SDUSBP ≥ 155 mm Hg. Home BP measurements (HBPM) are obtained twice on the day after the midweek dialysis. Ambulatory Blood Pressure Monitoring (ABPM) during a 44h interdialytic period is obtained quarterly. We compared SDUSBP, HBPM and ABPM. Results: We enrolled 281 and randomized 126 participants. Major reasons for drop out during the baseline period were 2-week mean SDUSBP < 155 mm Hg (40.6%), no cardiac MRI (13.0%) and perception of protocol as burdensome (11.2%). Adherence with prescribed SDUSBP was satisfactory. The percent of patients with ≥ 4, ≥ 8 and ≥12 SBP per month were 96, 88 and 57% in month 1 and 78, 68 and 37% in month 12. In a constant cohort of participants followed ≥ 330 days 2-week mean SDUSBP were 144 ± 17.4 and 156 ± 15.2 mm Hg in the intensive and usual arms, respectively. Major reasons that participants in the intensive arm did not achieve target SBP included large interdialytic weight gain (27.2%), non-adherence with medications or dialysis prescription (40.9%), and intradialytic hypotension (31.9%). Differences between the SDUSBP and both HBPM and ABPM were often ≥ 10 mm Hg. Optimal control of BP requires measurements in and out of the dialysis unit. Rates of adverse events were similar to those in other NIDDK funded ESRD studies. Conclusion: The difference in BP between arms was achieved and maintained throughout the study. It is feasible to conduct a full-scale clinical trial of intensive vs. usual treatment of hypertension in HD patients.

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