BLOOD PRESSURE CONTROL STATUS IN DIALYSIS PATIENTS

Objective: Blood pressure (BP) management is important for dialysis patients, because hypertension is a powerful risk factor of cardiovascular disease. However, the BP of the dialysis patients is strongly influenced by body fluid volume reduction during dialysis session and by weight gain until the next dialysis. It is reported that the larger the variation of BP during dialysis is, the worse the prognosis is. In this study, we examined BP control status during dialysis in patients on maintenance hemodialysis. Design and method: Subjects comprised 298 patients on hemodialysis (197 males, 101 females, mean age 68 ± 13 years old) who had been regularly followed at Kokura Daiichi Hospital. We assessed BP during dialysis, antihypertensive medication and comorbidity. Results: Average BP before and after dialysis were 142 ± 18/76 ± 12 and 132 ± 17/72 ± 11 mmHg, respectively. The achievement rate of target BP before dialysis (<140/90 mmHg) was 44%. Forty-one % of all patients were classified as intradialytic hypotension (systolic BP falls by 20 mmHg or more during dialysis). Thirty-one % of the patients with intradialytic hypotension had taken some vasopressors. The patients with uncontrolled BP before dialysis took greater number of antihypertensive drugs compared to good controlled patients. They were younger and showed shorter dialysis history, and higher prevalence of diabetes mellitus and intradialytic hypotension. In a multivariate analysis, predialytic systolic BP correlated positively with body mass index, intradialytic hypotension and diabetic nephropathy and negatively with dialysis history. Conclusions: The achievement rate of target BP before dialysis was low in our dialysis patients, and many patients showed intradialytic hypotension. Predialytic systolic BP was associated with higher body mass index and prevalence of intradialytic hypotension.