Summary:
Introduction: Blood pressure (BP) evaluation and management in patients with
end stage renal disease (ESRD) is often a matter of debate. During hemodialysis
(HD) hypotension as well as a paradoxical rise in BP may be documented.
Aim: The aim of the study was to investigate the circadian BP behavior in ESRD
hemodialysis patients.
Methods: We studied 19 patients with ESRD (68,4% men, mean age 67.1±17,1 years,
52% hypertensive) that underwent HD three times a week in the HD unit the
general hospital of Athens Ippokrateio. Clinic BP was measured before and after
HD with sphygmomanometer of the HD unit.The Ambulatory BP monitoring was
applied one hour before an HD session and was set to measure BP every 30
minutes and until arrival for the next HD session, for a total of two
subsequent 24-hour periods.
Blood pressure dipping was defined as [(daytime systolic BP – nighttime
systolic BP)/ daytime systolic BP. Patients were defined as dippers if BP
dipping from daytime to nighttime was >10% ,non-dippers if BP dipping 0-10 %
and risers if BP dipping <0%.
Results: Body weight before and after the HD session was 77.7±28.1Kgr and
74.9±26.8mmHg respectively. Clinic systolic/diastolic BP before the HD session
was 133±23/66±11 mmHg and after the HD session was 126±25/69±12 mmHg.
Ambulatory systolic/diastolic BP increased not significantly from 127.9±22.
4/71.7±12.8 mmHg to 129.3±18.6/71.6±11.5 mmHg (p>0.05) from the first to the
second 24-hour period. Increases were also non-significant for daytime and
nighttime systolic BP in the first and the second 24 hour period (127,9±22 mmHg
vs 126,1±19 mmHg and 129,3±25 mmHg vs 131±21 mmHg respectively, p>0.05). Obese
patients had significant increased heart rate at all measurement phases in
relation to the other categories of patients (p<0,05).
Mean dipping was 1.6±7.9% in the first day and further decreased to -0.94±6.9%
in the second day. Accordingly, in the first 24-hour period, only 3 patients
(16%) were dippers and reduced to 1 patient in the following day
(1%).Non-dippers were 8 patients(42%) at the first and 9 patients (48%) at the
second 24-hour period. Risers were 8 patients (42%) at the first and 9 patients
(47%) at the second 24-hour period respectively.
Conclusions: Daytime systolic BP does not substantially change during the
48-hour period extending from HD to HD session. A non-dipper as well as a riser
pattern is very frequent undergoing chronic haemodialysis. Body weight
increase affects the increase of the BP.
Keywords:
Hemodialysis, Hypertansion, Blood pressure, Vital signs
