Prevalence and Risk Factors of Hypertension in Hemodialysis

Taieb Ben  Abdallah; Imed  Helal; Fathi  Younsi; Madiha  Mahfoudhi; Imen  Gorsane

doi:10.4236/ojneph.2015.52009

Imen Gorsane, Madiha Mahfoudhi^*, Fathi Younsi, Imed Helal, Taieb Ben Abdallah

Abstract: The prevalence of hypertension in iterative hemodialysis (HD) remains high and was associated with a high morbidity and mortality. It was a single-center retrospective study including 124 pa-tients on chronic HD in our unit. The prevalence of hypertension was determined from blood pressure (BP) monitoring in beginning, middle and end of dialysis. We defined hypertension as systolic BP (SBP) greater than or equal to 140 mmHg and/or diastolic BP (DBP) greater than or equal to 90 mmHg on at least two measures. We have established a comparative study between the group of hypertensive dialysis and those not hypertensive. The prevalence of hypertension was 69.35% (86/124). The mean age was 57.15 years with a sex ratio of 1.2. Echocardiograms, performed in 64.5% of patients, showed a high prevalence of cardiac consequences of hypertension with left ventricular hypertrophy in 80% of patients and an average ejection fraction of 62%. Diabetes, dialysis one session per week and the non-compliance with lifestyle and dietary rules were significantly associated with hypertension in HD in our study. The effect of HD on BP is dose-dependent. The reduction of BP allows a lower risk of cardiovascular (CV) events and mortality in hypertensive patients.

Keywords: Hemodialysis, Blood Pressure, Hypertension, Ultrafiltration, Volume Expansion

Cite this paper: Gorsane, I. , Mahfoudhi, M. , Younsi, F. , Helal, I. and Abdallah, T. (2015) Prevalence and Risk Factors of Hypertension in Hemodialysis. Open Journal of Nephrology, 5, 54-60. doi: 10.4236/ojneph.2015.52009.

References

[1] Thompson, S., Hemmelgarn, B., Wiebe, N., Majumdar, S., Klarenbach, S., Jindal, K., et al. (2012) Clinical Decision Support to Improve Blood Pressure Control in Hemodialysis Patients: A Non Randomized Controlled Trial. Journal of Nephrology, 25, 944-953.
http://dx.doi.org/10.5301/jn.5000238

[2] Gul, A., Miskulin, D., Gassman, J., Harford, A., Horowitz, B., Chen, J., et al. (2014) Design of the Blood Pressure Goals in Dialysis Pilot Study. American Journal of the Medical Sciences, 347, 125-130.
http://dx.doi.org/10.1097/MAJ.0b013e31827daee5

[3] Agarwal, R., Nissenson, A., Battle, D., Coyne, D., Trout, J. and Warnock D. (2003) Prevalence, Treatment, and Control of Hypertension in Chronic Hemodialysis Patients in the United States. The American Journal of Medicine, 115, 291-297.
http://dx.doi.org/10.1016/S0002-9343(03)00366-8

[4] Van Buren, P.N. and Inrig, J.K. (2012) Hypertension and Hemodialysis: Pathophysiology and Outcomesin Adult and Pediatric Populations. Pediatric Nephrology, 27, 339-350.
http://dx.doi.org/10.1007/s00467-011-1775-3

[5] Inrig, J., Oddone, E., Hasselblad, V., Gillespie, B., Patel, U.D., Reddan, D., et al. (2007) Association of Intradialytic Blood Pressure Changes with Hospitalization and Mortality Rates in Prevalent ESRD Patients. Kidney International, 71, 454-461.
http://dx.doi.org/10.1038/sj.ki.5002077

[6] Foley, R., Parfrey, P., Darnett, J., Kent, G., Murray, D. and Barre, P. (1996) Impact of Hypertension on Cardiomyopathy, Morbidity, and Mortality in End-Stage Renal Disease. Kidney International, 49, 1379-1385.
http://dx.doi.org/10.1038/ki.1996.194

[7] Heerspink, H.J., Ninomya, T., Zoungas, S., de Zeeuw, D., Grobbee, D.E., Jardine, M.J., et al. (2009) Effect of Lowering Blood Pressure on Cardiovascular Events and Mortality in Patients on Dialysis: A Systematic Review and Meta-Analysis of Randomised Controlled Trials. The Lancet, 373, 1009-1015.
http://dx.doi.org/10.1016/S0140-6736(09)60212-9

[8] K/DOQI Workgroup (2005) K/DOQI Clinical Practice Guidelines for Cardiovascular Disease in Dialysis Patients. American Journal of Kidney Diseases, 45, S1-S153.

[9] Agarwal, R., Brim, N.J., Mahenthiran, J., Andersen, M.J. and Saha, C. (2006) Out-of-Hemodialysis-Unit Blood Pressure is a Superior Determinant of Left Ventricular Hypertrophy. Hypertension, 47, 62-68.
http://dx.doi.org/10.1161/01.HYP.0000196279.29758.f4

[10] Inrig, J., Patel, U., Gillespie, B., Hasselblad, V., Himmelfarb, J., Reddan D., et al. (2007) Relationship between Interdialytic Weight Gain and Blood Pressure Among Prevalent Hemodialysis Patients. American Journal of Kidney Diseases, 50, 108.e4-118.e4.
http://dx.doi.org/10.1053/j.ajkd.2007.04.020

[11] Agarwal, R. (2010) Blood Pressure and Mortality among Hemodialysis Patients. Hypertension, 55, 762-768.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.109.144899

[12] Harvey, P., Holt, A., Nicholas, J. and Dasgupta, I. (2013) Is an Average of Routine Postdialysis Blood Pressure a Good Indicator of Blood Pressure Control and Cardiovascular Risk? Journal of Nephrology, 26, 94-100.
http://dx.doi.org/10.5301/jn.5000119

[13] Borsboom, H., Smans, L., Cramer, M.J., Kelder, J.C., Kooistra, M.P., Vos, P.F., et al. (2005) Long-Term Blood Pressure Monitoring and Echocardiographic Findings in Patients with End-Stage Renal Disease: Reverse Epidemiology Explained? Netherlands Journal of Medicine, 63, 399-406.

[14] Agarwal, R. (2012) The Controversies of Diagnosing and Treating Hypertension among Hemodialysis Patients. Seminars in Dialysis, 25, 370-376.
http://dx.doi.org/10.1111/j.1525-139X.2012.01092.x

[15] Agarwal, R., Alborzi, P., Satyan, S. and Light, R.P. (2009) Dry-Weight Reduction in Hypertensive Hemodialysis Patients (DRIP): A Randomized, Controlled Trial. Hypertension, 53, 500-507.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.125674

[16] London, G.M. (2011) Ultrafiltration Intensification for Achievement of Dry Weight and Hypertension Control Is Not Always the Therapeutic Gold Standard. Journal of Nephrology, 24, 395-397.
http://dx.doi.org/10.5301/jn.5000006

[17] Alborzi, P., Patel, N. and Agarwal, R. (2007) Home Blood Pressures Are of Greater Prognostic Value than Hemodialysis Unit Recordings. Clinical Journal of the American Society of Nephrology, 2, 1228-1234.
http://dx.doi.org/10.2215/CJN.02250507

[18] Levin, N.W., Kotanko, P., Eckardt, K.U., Kasiske, B.L., Chazot, C., Cheung, A.K., et al. (2010) Blood Pressure in Chronic Kidney Disease Stage 5D-Report from a Kidney Disease: Improving Global Outcomes Controversies Conference. Kidney International, 77, 273-284.
http://dx.doi.org/10.1038/ki.2009.469

[19] Charra, B. (2007) Fluid Balance, Dry Weight, and Blood Pressure in Dialysis. Hemodialysis International, 11, 21-31.
http://dx.doi.org/10.1111/j.1542-4758.2007.00148.x

[20] Curatola, G., Bolignano, D., Rastelli, S., Caridi, G., Tripepi, R., Tripepi, G., et al. (2011) Ultrafiltration (UF) Intensification Improves Hypertension Control in Hemodialysis Patients but Increases Arterio-Venous Fistula Complications and Cardiovascular Events. Journal of Nephrology, 24, 465-473.
http://dx.doi.org/10.5301/JN.2011.7735

[21] Zimmerman, D.L., Ruzicka, M., Hebert, P., Fergusson, D., Touyz, R.M. and Burns, K.D. (2014) Short Daily versus Conventional Hemodialysis for Hypertensive Patients: A Randomized Cross-Over Study. PLoS ONE, 9, e97135.
http://dx.doi.org/10.1371/journal.pone.0097135

[22] Chertow, G.M., Levin, N.W., Beck, G.J., Depner, T.A., Eggers, P.W., et al., The FHN Trial Group (2010) In-Center Hemodialysis Six Times per Week versus Three Times per Week. New England Journal of Medicine, 363, 2287-2300.
http://dx.doi.org/10.1056/NEJMoa1001593

[23] Chan, C., Floras, J., Miller, J., Richardson, R. and Pierratos, A. (2002) Regression of Left Ventricular Hypertrophy after Conversion to Nocturnal Hemodialysis. Kidney International, 61, 2235-2239.
http://dx.doi.org/10.1046/j.1523-1755.2002.00362.x

[24] Liu, M., Takashi, H., Morita, Y., Maruyama, S., Mizuno, M., Yuzawa, Y., et al. (2003) Non-Dipping Is a Potent Predictor of Cardiovascular Mortality and Is Associated with Autonomic Dysfunction in Haemodialysis Patients. Nephrology Dialysis Transplantation, 18, 563-569.
http://dx.doi.org/10.1093/ndt/18.3.563

[25] Heerspink, H., Ninomiya, T., Zoungas, S., de Zeeuw, D., Grobbee, D.E., Jardine, M.J., et al. (2009) Effect of Lowering Blood Pressure on Cardiovascular Events and Mortality in Patients on Dialysis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. The Lancet, 373, 1009-1015.
http://dx.doi.org/10.1016/S0140-6736(09)60212-9

[26] Agarwal, R. and Sinha, A.D. (2009) Cardiovascular Protection with Antihypertensive Drugs in Dialysis Patients: Systematic Review and Meta-Analysis. Hypertension, 53, 860-866.
http://dx.doi.org/10.1161/HYPERTENSIONAHA.108.128116

[27] Krapf, R. and Hulter, H.N. (2009) Arterial Hypertension Induced by Erythropoietin and Erythropoiesis-Stimulating Agents (ESA). Clinical Journal of the American Society of Nephrology, 4, 470-480.
http://dx.doi.org/10.2215/CJN.05040908