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Introduction <p>The association between intradialytic hypotension (IDH), peridialytic blood pressure variation (BPV), and their impact on cardiovascular disease (CVD) and mortality has been debated for many years. This study investigated risk factors in patients with IDH compared with those with BPV undergoing regular hemodialysis.</p> Methods <p>A total of 100 hemodialysis patients were evaluated by a cardiologist over a one-year period. Patients who had frequent (more than 30%) systolic blood pressure changes of ≥ 30 mmHg in consecutive peridialytic blood pressure charts (before, during, and after dialysis, as well as visit to visit) were classified as having BPV. IDH was defined as a drop in systolic blood pressure of more than 20 mmHg or a drop in mean blood pressure of more than 10 mmHg, often accompanied by symptoms. The relationship between IDH and BPV and CVD, as well as other risk factors, was assessed.</p> Results <p>IDH and BPV were observed in 24% and 19% of participants, respectively. Hypertension, diabetes, and coronary artery disease were present in 72%, 34%, and 21% of patients, respectively. Left ventricular ejection fraction &lt; 50%, left ventricular hypertrophy, and grade 2 or 3 diastolic dysfunction were identified in 84%, 67%, and 47% of patients, respectively. IDH occurred more frequently in women, diabetic patients, individuals with lower resting heart rates, and those using diuretics. BPV was associated with left ventricular hypertrophy, grade 2 or 3 diastolic dysfunction, and hypertension. Renal-related cardiac risk factors showed no association with either IDH or BPV.</p> Conclusion <p>BPV appears to have greater predictive value for CVD than IDH in hemodialysis patients, whereas IDH is primarily an indicator of autonomic dysfunction.</p> <p><b>Key learning points</b></p> What was known <p>The relationship between pressure fluctuation in hemodialysis patients and cardiovascular condition has been of interest for a long time. But the available results are contradictory and incomplete, and the complete relationship between heart and risk factors with blood pressure fluctuation of these patients has been investigated less.</p> This study adds <p>According to our study, peridialysis pressure variation is mainly related to cardiac abnormality (ventricular hypertrophy-diastolic dysfunction) and intradialytic hypotension is mainly related to autonomic dysfunction (diabetes-low heart rate).</p> Potential impact <p>Blood pressure variation in hemodialysis patients can be an alarm of the risk of cardiac involvement compared to intradialysis hypotension. Therefore, patients with pressure variation should be prioritized for cardiac examination.</p>

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Association of Cardiovascular Status and Peridialytic Blood Pressure Variation Compared to Intradialytic Hypotension in Hemodialysis Patients

  • 期刊论文

  • 发表日期：

    2025年10月24日

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  • Hakimeh Saadatifar,
  • Saber Rostami,
  • Zahra Eslamifar,
  • Khojasteh Marashi,
  • Soraya Khajehrezaei,
  • Aziz Kasani

摘要

Introduction

The association between intradialytic hypotension (IDH), peridialytic blood pressure variation (BPV), and their impact on cardiovascular disease (CVD) and mortality has been debated for many years. This study investigated risk factors in patients with IDH compared with those with BPV undergoing regular hemodialysis.

Methods

A total of 100 hemodialysis patients were evaluated by a cardiologist over a one-year period. Patients who had frequent (more than 30%) systolic blood pressure changes of ≥ 30 mmHg in consecutive peridialytic blood pressure charts (before, during, and after dialysis, as well as visit to visit) were classified as having BPV. IDH was defined as a drop in systolic blood pressure of more than 20 mmHg or a drop in mean blood pressure of more than 10 mmHg, often accompanied by symptoms. The relationship between IDH and BPV and CVD, as well as other risk factors, was assessed.

Results

IDH and BPV were observed in 24% and 19% of participants, respectively. Hypertension, diabetes, and coronary artery disease were present in 72%, 34%, and 21% of patients, respectively. Left ventricular ejection fraction < 50%, left ventricular hypertrophy, and grade 2 or 3 diastolic dysfunction were identified in 84%, 67%, and 47% of patients, respectively. IDH occurred more frequently in women, diabetic patients, individuals with lower resting heart rates, and those using diuretics. BPV was associated with left ventricular hypertrophy, grade 2 or 3 diastolic dysfunction, and hypertension. Renal-related cardiac risk factors showed no association with either IDH or BPV.

Conclusion

BPV appears to have greater predictive value for CVD than IDH in hemodialysis patients, whereas IDH is primarily an indicator of autonomic dysfunction.

Key learning points

What was known

The relationship between pressure fluctuation in hemodialysis patients and cardiovascular condition has been of interest for a long time. But the available results are contradictory and incomplete, and the complete relationship between heart and risk factors with blood pressure fluctuation of these patients has been investigated less.

This study adds

According to our study, peridialysis pressure variation is mainly related to cardiac abnormality (ventricular hypertrophy-diastolic dysfunction) and intradialytic hypotension is mainly related to autonomic dysfunction (diabetes-low heart rate).

Potential impact

Blood pressure variation in hemodialysis patients can be an alarm of the risk of cardiac involvement compared to intradialysis hypotension. Therefore, patients with pressure variation should be prioritized for cardiac examination.