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Prevalence and Risk Factors of Hypertension in Hemodialysis  [PDF]
Imen Gorsane, Madiha Mahfoudhi, Fathi Younsi, Imed Helal, Taieb Ben Abdallah
Open Journal of Nephrology (OJNeph) , 2015, DOI: 10.4236/ojneph.2015.52009
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.
Diabetes and Hypertension among Patients Receiving Antiretroviral Treatment Since 1998 in Senegal: Prevalence and Associated Factors  [PDF]
Assane Diouf,Amandine Cournil,Khadidiatou Ba-Fall,Ndèye Fatou Ngom-Guèye,Sabrina Eymard-Duvernay,Ibrahima Ndiaye,Gilbert Batista,Papa Mandoumbé Guèye,Pape Samba Ba,Bernard Taverne,Eric Delaporte,Papa Salif Sow
ISRN AIDS , 2012, DOI: 10.5402/2012/621565
Abstract: Cardiovascular risk factors in people on antiretroviral treatment (ART) are poorly documented in resource-constrained settings. A cross-sectional study was conducted in 2009 to assess prevalence of diabetes and hypertension in a sample of 242 HIV-infected patients who had initiated ART between 1998 and 2002 in Dakar, Senegal (ANRS 1215 observational cohort). World Health Organization (WHO) criteria were applied to diagnose diabetes and hypertension. Multiple logistic regressions were used to identify factors associated with diabetes and hypertension. Patients had a median age of 46 years and had received ART for a median duration of about 9 years. 14.5% had diabetes and 28.1% had hypertension. Long duration of ART (≥119 months), older age, higher body mass index (BMI), and higher levels of total cholesterol were associated with higher risks of diabetes. Older age, higher BMI at ART initiation, and higher levels of triglycerides were associated with higher risk of hypertension. This study shows that diabetes and hypertension were frequent in these Senegalese HIV patients on ART. It confirms the association between duration of ART and diabetes and highlights the need to implement programs for prevention of cardiovascular risk factors in HIV patients from resource-constrained settings. 1. Introduction In December 2010, over five million people were on antiretroviral treatment (ART) in Sub-Saharan Africa [1]. In Senegal, this number reached 18,000 at the end of 2011, corresponding to a coverage rate of 78% [2]. The efficacy of ART has led to a significant reduction in mortality among people living with HIV [3–6], causing an increase in their life expectancy, which nevertheless remains below that of the general population [7–10]. This excess mortality is partially related to immunodepression but also organic and metabolic disorders that are not classified as AIDS [4, 11–16]. These disorders have multifactor causes. The underlying physiopathological mechanisms have not been clearly established. Nevertheless, it is recognized that they involve phenomena related to the virus [17–21], to antiretrovirals (ARVs) [22–26], and to the host [27–31]. These mechanisms contribute to noninfectious diseases including diabetes and hypertension, which are two major risk factors of cardiovascular disease and are associated with increased mortality and morbidity. Available data on prevalence and the factors associated with diabetes and hypertension have dealt with populations of varying ages and whose duration of ARV exposure varied greatly. These studies have rarely addressed
Prevalence of Hypertension among Iranian Hemodialysis Patients and Associated Risk Factors: A Nationwide Multicenter Study  [PDF]
Eghlim Nemati,Fahimeh Ghanbarpour,Saeed Taheri,Behzad Einollahi
Pakistan Journal of Biological Sciences , 2008,
Abstract: The aim of this study is to document the prevalence of HTN and characterize risk factors associated with HTN in Iranian hemodialysis patients. Three hundred and thirty seven HD patients from 5 university based HD centers around Iran were enrolled in the study. Urea reduction ratio was calculated using formula: 100 * (1-(urea before HD/urea after HD)). Pearson Chi-square test, independent sample t-test and one way ANOVA were used for evaluations, where appropriate. Multivariate logistic regression model was used for defining independent risk factors. Two sided p<0.05 were considered significant. Patients with diabetes mellitus and hypertension as causes of ESRD significantly were more likely to have hypertension before and after dialysis (p<0.05). Patients with conventional thrice weekly dialysis (compared to twice), hemodialysis duration of more that 6 months, acetate type of dialysate, ESRD cause when diabetes mellitus and hypertension, were significantly associated with having pre-HD hypertension. We also found that hemodialysis center of the capital city had a significant better measures compared to other cities (p<0.05). This study revealed a relatively acceptable prevalence of hypertension in our HD population. Nevertheless, because of higher prevalence of HTN in HD centers out of capital city, it seems necessary that we should urgently pay more attention in promotion of these centers toward achieving better outcome with implementing strict guidelines to follow
Epidemiología de la hipertensión en hemodiálisis crónica Prevalence of hypertension among patients on chronic hemodialysis  [cached]
Antonio Vukusich C,Alberto Fierro C,Jorge Morales B,Andrés Fantuzzi S
Revista médica de Chile , 2002,
Abstract: Background: Hypertension is a common and important cardiovascular risk factor in patients on chronic hemodialysis. Aim: To report the prevalence and characteristics of hypertension among patients on chronic hemodialysis. Patients and methods: Cross sectional study of 313 patients (192 male, aged 57 ± 18 years) dialyzed in 7 representative centers in Santiago, Chile. Results: Patients were on hemodialysis for a mean of 68 ± 53 months and 67 (21%) were diabetic. 230 (74%) were hypertensive and 223 of these (97%) had predialysis hypertension. A multivariate analysis showed that hypertension was associated with increased weight gain between dialysis, failure to achieve the postdialysis dry weight, increasing age and the presence of diabetes. Among hypertensive patients, 61% were receiving antihypertensive medications, compared with 27% of patients with normal blood pressure. Conclusions: High blood pressure is highly prevalent among patients on chronic hemodialysis and is associated to hypervolemia, age and the presence of diabetes (Rev Méd Chile 2002; 130: 610-5)
A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance
Kumudha Ramasubbu, Anita Deswal, Cheryl Herdejurgen
International Journal of General Medicine , 2010, DOI: http://dx.doi.org/10.2147/IJGM.S12946
Abstract: prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance Original Research (4278) Total Article Views Authors: Kumudha Ramasubbu, Anita Deswal, Cheryl Herdejurgen Published Date September 2010 Volume 2010:3 Pages 279 - 286 DOI: http://dx.doi.org/10.2147/IJGM.S12946 Kumudha Ramasubbu1, Anita Deswal1, Cheryl Herdejurgen2, David Aguilar1, Adaani E Frost2 1Section of Cardiology, Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA; 2Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USA Background: Pulmonary hypertension (PH), a disease which carries substantial morbidity and mortality, has been reported to occur in 25%–45% of dialysis patients. No prospective evaluation of the prevalence or clinical significance of PH in chronic dialysis patients in the United States (US) has been undertaken. Methods: Echocardiograms were performed prospectively in chronic hemodialysis patients prior to dialysis at a single dialysis center. PH was defined as a tricuspid regurgitant jet ≥2.5 m/s and “more severe PH” as ≥3.0 m/s. Clinical outcomes recovered were all-cause hospitalizations and death at 12 months. Results: In a cohort of 90 patients, 42 patients (47%) met the definition of PH. Of those, 18 patients (20%) met the definition of more severe PH. At 12 months, mortality was significantly higher in patients with PH (26%) compared with patients without PH (6%). All-cause hospitalizations were similar in patients with PH and without PH. Echocardiographic findings suggesting impaired left ventricular function and elevated pulmonary capillary wedge pressure were significantly associated with PH. Conclusion: This prospective cross-sectional study of a single dialysis unit suggests that PH may be present in nearly half of US dialysis patients and when present is associated with increased mortality. Echocardiographic findings demonstrate an association between elevated filling pressures, elevated pulmonary artery pressures, and higher mortality, suggesting that the PH may be secondary to diastolic dysfunction and compounded by volume overload.
Intradialytic versus home based exercise training in hemodialysis patients: a randomised controlled trial
Kirsten P Koh, Robert G Fassett, James E Sharman, Jeff S Coombes, Andrew D Williams
BMC Nephrology , 2009, DOI: 10.1186/1471-2369-10-2
Abstract: This is a randomised, controlled clinical trial. A total of 72 hemodialysis patients will be randomised to receive either six months of intradialytic exercise training, home-based exercise training or usual care. Intradialytic patients will undergo three training sessions per week on a cycle ergometer and home-based patients will be provided with a walking program to achieve the same weekly physical activity. Primary outcome measures are six-minute walk distance (6 MWD) and aortic pulse wave velocity (PWV). Secondary outcome measures include augmentation index, peripheral and central blood pressures, physical activity and self-reported health. Measures will be made at baseline, three and six months.The results of this study will help determine the efficacy of home-based exercise training in hemodialysis patients. This may assist in developing exercise guidelines specific for these patients.ACTRN12608000247370A number of studies have shown that intradialytic exercise training has positive effects on patients, such as improving cardiorespiratory fitness, physical function and self-reported health [1]. Less work has focussed on the effects of exercise training on cardiovascular risk factors in dialysis patients although some evidence suggests improvements in fasting glucose and insulin, an enhancement in the management of hypertension, and a reduction in inflammation [2-5].Cardiovascular pathologies observed in ESKD patients include left ventricular hypertrophy and arterial disease [6]. In addition to the characteristic lesions of atherosclerosis, dialysis patients also experience thickening and fibrosis of the arterial wall in response to pressure and volume overload, loss of elastic fibres and medial fibrosis [7]. Such arterial remodelling, along with medial calcification, causes arteries to stiffen, thereby exacerbating left ventricular dysfunction [8]. Indeed, widening of the pulse pressure, the simplest and crudest method of assessing arterial stiffness, has prove
A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States: prevalence and clinical significance  [cached]
Kumudha Ramasubbu,Anita Deswal,Cheryl Herdejurgen
International Journal of General Medicine , 2010,
Abstract: Kumudha Ramasubbu1, Anita Deswal1, Cheryl Herdejurgen2, David Aguilar1, Adaani E Frost21Section of Cardiology, Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, Texas, USA; 2Section of Pulmonary and Critical Care Medicine, Baylor College of Medicine, Houston, Texas, USABackground: Pulmonary hypertension (PH), a disease which carries substantial morbidity and mortality, has been reported to occur in 25%–45% of dialysis patients. No prospective evaluation of the prevalence or clinical significance of PH in chronic dialysis patients in the United States (US) has been undertaken.Methods: Echocardiograms were performed prospectively in chronic hemodialysis patients prior to dialysis at a single dialysis center. PH was defined as a tricuspid regurgitant jet ≥2.5 m/s and “more severe PH” as ≥3.0 m/s. Clinical outcomes recovered were all-cause hospitalizations and death at 12 months.Results: In a cohort of 90 patients, 42 patients (47%) met the definition of PH. Of those, 18 patients (20%) met the definition of more severe PH. At 12 months, mortality was significantly higher in patients with PH (26%) compared with patients without PH (6%). All-cause hospitalizations were similar in patients with PH and without PH. Echocardiographic findings suggesting impaired left ventricular function and elevated pulmonary capillary wedge pressure were significantly associated with PH.Conclusion: This prospective cross-sectional study of a single dialysis unit suggests that PH may be present in nearly half of US dialysis patients and when present is associated with increased mortality. Echocardiographic findings demonstrate an association between elevated filling pressures, elevated pulmonary artery pressures, and higher mortality, suggesting that the PH may be secondary to diastolic dysfunction and compounded by volume overload.Keywords: renal failure, pulmonary hypertension, diastolic dysfunction
Pulmonary Hypertension in Hemodialysis Patients  [cached]
Mahdavi-Mazdeh Mitra,Alijavad-Mousavi Seyed,Yahyazadeh Hooman,Azadi Mitra
Saudi Journal of Kidney Diseases and Transplantation , 2008,
Abstract: The aim of this study was to evaluate the prevalence of primary pulmonary hypertension (PHT) among hemodialysis patients and search for possible etiologic factors. The prevalence of PHT was prospectively estimated by Doppler echocardiogram in 62 long-term hemodialysis patients on the day post dialysis. PHT (> 35 mm Hg) was found in 32 (51.6%) patients with a mean systolic pulmonary artery pressure of 39.6 ± 13.3 mmHg. The hemoglobin and albumin levels were significantly lower in the PHT subgroup (11.1 ± 1.86 vs 9.8 ± 1.97 g/dL and 3.75 ± 0.44 vs 3.38 ± 0.32 g/dL, p = 0.01 and 0.02, respectively). Our study demonstrates a surprisingly high prevalence of PHT among patients receiving long-term hemodialysis. Early detection is important in order to avoid the serious consequences of the disease.
Sympathetic Activation and Baroreflex Function during Intradialytic Hypertensive Episodes  [PDF]
Dvora Rubinger, Rebecca Backenroth, Dan Sapoznikov
PLOS ONE , 2012, DOI: 10.1371/journal.pone.0036943
Abstract: Background The mechanisms of intradialytic increases in blood pressure are not well defined. The present study was undertaken to assess the role of autonomic nervous system activation during intradialytic hypertensive episodes. Methodology/Principal Findings Continuous interbeat intervals (IBI) and systolic blood pressure (SBP) were monitored during hemodialysis in 108 chronic patients. Intradialytic hypertensive episodes defined as a period of at least 10 mmHg increase in SBP between the beginning and the end of a dialysis session or hypertension resistant to ultrafiltration occurring during or immediately after the dialysis procedure, were detected in 62 out of 113 hemodialysis sessions. SBP variability, IBI variability and baroreceptor sensitivity (BRS) in the low (LF) and high (HF) frequency ranges were assessed using the complex demodulation technique (CDM). Intradialytic hypertensive episodes were associated with an increased (n = 45) or decreased (n = 17) heart rate. The maximal blood pressure was similar in both groups. In patients with increased heart rate the increase in blood pressure was associated with marked increases in SBP and IBI variability, with suppressed BRS indices and enhanced sympatho-vagal balance. In contrast, in those with decreased heart rate, there were no significant changes in the above parameters. End-of- dialysis blood pressure in all sessions associated with hypertensive episode was significantly higher than in those without such episodes. In logistic regression analysis, predialysis BRS in the low frequency range was found to be the main predictor of intradialytic hypertension. Conclusion/Significance Our data point to sympathetic overactivity with feed-forward blood pressure enhancement as an important mechanism of intradialytic hypertension in a significant proportion of patients. The triggers of increased sympathetic activity during hemodialysis remain to be determined. Intradialytic hypertensive episodes are associated with higher end-of- dialysis blood pressure, suggesting that intradialytic hypertension may play a role in generation of interdialytic hypertension.
Intradialytic Hypertension and Associated Factors among Chronic Haemodialysed Patients in Sub-Saharan Africa: An Example from Cameroon  [PDF]
Halle Marie Patrice, Bana Eric Lo?c, Fouda Hermine, Nda Mefo’o Jean Pierre, Tewafeu Denis, Kaze Folefack Fran?ois, Ashuntantang Enow Gloria
Open Journal of Nephrology (OJNeph) , 2018, DOI: 10.4236/ojneph.2018.84012
Abstract: Background: Hemodialysis (HD) is a therapy during which complications such as intradialytic hypertension (IDH) are frequent. We aimed to determine the incidence of IDH and associated factors amongst patients on maintenance hemodialysis in Cameroon. Method: It was a prospective cohort study including end stage kidney disease patients on HD. Data collected were: socio-demographic, comorbidities, current medication, weight, heart rate ultrafiltration rate (UF), albuminemia and electrocardiogram. The first blood pressure (BP) measurement was obtained at the beginning of the session and the last at the end. IDH was defined as an increase in systolic BP ≥ 10 mmHg between the first and the last measurement. Logistic regression was used to look for associated factors, p-value < 0.05 was considered significant. Results: Mean age was 49.06 ± 13.97 years with 64.2% males. Mean number of dialysis session was 11.26 ± 2.49. Incidence of IDH was 48.36%. The median number of IDH episodes was 5 (Range 0 - 12). Factors increasing the risk were hypertension (p = 0.003), number of antihypertensive drugs ≥ 2 (p < 0.001), blood transfusion during the session (p < 0.001), male gender (p = 0.038) and a monthly income < 35000 XAF (p = 0.033). Factors lowering the risk were age ≥ 50 years (p = 0.012), longer duration on dialysis (p < 0.001), dry weight ≥ 67 kg (p < 0.001), UF ≥ 800 ml/h (p < 0.001) and a BP ≥ 140/90 mmHg at the beginning of the session (p < 0.001). Conclusion: IDH is frequent amongst patients on maintenance hemodialysis in our setting, with various patients related factors associated.
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