The Korean journal of internal medicine

  • 제32권1호
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  • Pages.117-124
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  • 2017
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  • 1226-3303(pISSN)
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  • 2005-6648(eISSN)
대한내과학회 (The Korean Association of Internal Medicine)
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Which dialysis unit blood pressure is the most accurate for predicting home blood pressure in patients undergoing hemodialysis?

  • Yoon, In-Cheol (Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine) ;
  • Choi, Hye-Min (Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine) ;
  • Oh, Dong-Jin (Department of Internal Medicine, Myongji Hospital, Seonam University College of Medicine)
  • 투고 : 2015.08.16
  • 심사 : 2015.10.03
  • 발행 : 2017.01.01
⟨ 이전 논문 다음 논문 ⟩

초록

Background/Aims: We investigated which dialysis unit blood pressure (BP) is the most useful for predicting home BP in patients undergoing hemodialysis (HD). Methods: Patients undergoing HD who had been treated > 3 months were included in this study. Exclusion criteria were hospitalized patients with acute illness and changes in dry weight and anti-hypertensive drugs 2 weeks before the study. We used the dialysis unit BP recording data, such as pre-HD, intra-HD, post-HD, mean pre-HD, and post-HD (pre-post-HD), mean pre-HD, intra-HD, and post-HD (pre-intra-post-HD) BP. Home BP (the same period of dialysis unit BP) was monitored as a reference method during 2 weeks using the same automatic oscillometric device. Patients were asked to record their BP three times daily (wake up, between noon and 6:00 PM, and at bedtime). Results: Significant differences were detected between home systolic blood pressure (SBP) and pre-HD, post-HD, and intra-HD SBP (p = 0.003, p = 0.001, p = 0.016, respectively). In contrast, no differences were observed between home SBP and pre-intra-post-HD and pre-post-HD SBP (p = 0.235, p = 0.307, respectively). Areas under the receiver operating characteristic curve for pre-intra-post-HD and pre-post-HD SBP with 2-week home BP as the reference standard were 0.812 and 0.801, respectively. Conclusions: These results suggest that pre-intra-post-HD and pre-post-HD SBP had similar accuracy for predicting mean 2-week home SBP in HD patients. Therefore, pre-intra-post-HD and pre-post-HD SBP should be useful for predicting home SBP in HD patients if ambulatory or home BP measurements are unavailable.

키워드

참고문헌

  1. Collins AJ, Kasiske B, Herzog C, et al. USRDS 2006 Annual Data Report. Am J Kidney Dis 2006; 47(Suppl 1):1-286.
  2. Rayner HC, Pisoni RL, Bommer J, et al. Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Nephrol Dial Transplant 2004;19:108-120. https://doi.org/10.1093/ndt/gfg483
  3. Sarnak MJ, Levey AS, Schoolwerth AC, et al. Kidney disease as a risk factor for development of cardiovascular disease: a statement from the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention. Hypertension 2003;42:1050-1065. https://doi.org/10.1161/01.HYP.0000102971.85504.7c
  4. Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG. Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Am J Med 2003;115:291-297. https://doi.org/10.1016/S0002-9343(03)00366-8
  5. Hwang ES, Choi KJ, Kang DH, et al. Prevalence, predictive factor, and clinical significance of white-coat hypertension and masked hypertension in Korean hypertensive patients. Korean J Intern Med 2007;22:256-262. https://doi.org/10.3904/kjim.2007.22.4.256
  6. Jin DC. Major changes and improvements of dialysis therapy in Korea: review of end-stage renal disease registry. Korean J Intern Med 2015;30:17-22. https://doi.org/10.3904/kjim.2015.30.1.17
  7. Agarwal R, Brim NJ, Mahenthiran J, Andersen MJ, Saha C. Out-of-hemodialysis-unit blood pressure is a superior determinant of left ventricular hypertrophy. Hypertension 2006;47:62-68. https://doi.org/10.1161/01.HYP.0000196279.29758.f4
  8. Alborzi P, Patel N, Agarwal R. Home blood pressures are of greater prognostic value than hemodialysis unit recordings. Clin J Am Soc Nephrol 2007;2:1228-1234. https://doi.org/10.2215/CJN.02250507
  9. Agarwal R. Managing hypertension using home blood pressure monitoring among haemodialysis patients: a call to action. Nephrol Dial Transplant 2010;25:1766-1771. https://doi.org/10.1093/ndt/gfq171
  10. Agarwal R. Blood pressure and mortality among hemodialysis patients. Hypertension 2010;55:762-768. https://doi.org/10.1161/HYPERTENSIONAHA.109.144899
  11. Agarwal R. The controversies of diagnosing and treating hypertension among hemodialysis patients. Semin Dial 2012;25:370-376. https://doi.org/10.1111/j.1525-139X.2012.01092.x
  12. Agarwal R. Systolic hypertension in hemodialysis patients. Semin Dial 2003;16:208-213. https://doi.org/10.1046/j.1525-139X.2003.16041.x
  13. Agarwal R, Peixoto AJ, Santos SF, Zoccali C. Pre- and postdialysis blood pressures are imprecise estimates of interdialytic ambulatory blood pressure. Clin J Am Soc Nephrol 2006;1:389-398. https://doi.org/10.2215/CJN.01891105
  14. Davenport A, Cox C, Thuraisingham R. Achieving blood pressure targets during dialysis improves control but increases intradialytic hypotension. Kidney Int 2008;73:759-764. https://doi.org/10.1038/sj.ki.5002745
  15. Agarwal R, Metiku T, Tegegne GG, et al. Diagnosing hypertension by intradialytic blood pressure recordings. Clin J Am Soc Nephrol 2008;3:1364-1372. https://doi.org/10.2215/CJN.01510308
  16. Mitra S, Chandna SM, Farrington K. What is hypertension in chronic haemodialysis? The role of interdialytic blood pressure monitoring. Nephrol Dial Transplant 1999;14:2915-2921. https://doi.org/10.1093/ndt/14.12.2915
  17. Batlle DC, von Riotte A, Lang G. Delayed hypotensive response to dialysis in hypertensive patients with end-stage renal disease. Am J Nephrol 1986;6:14-20

피인용 문헌

  1. Interdialytic 24-Hours Ambulatory Blood Pressure versus Dialysis Unit Blood Pressure for the Diagnosis of Electrocardiographic-Left Ventricular Hypertrophy in Chronic Hemodialysis Black Patients vol.9, pp.11, 2019, https://doi.org/10.4236/wjcd.2019.911075