Interdialytic 24-Hours Ambulatory Blood Pressure versus Dialysis Unit Blood Pressure for the Diagnosis of Electrocardiographic-Left Ventricular Hypertrophy in Chronic Hemodialysis Black Patients
Background and Aim: In hemodialysis patients, 24-hours interdialytic ABPM better detects TOD than dialysis unit blood pressure. Therefore, the
present study was aimed to assess the diagnostic performance of 24-hours ABPM
vs. dialysis unit BPs for the diagnosis of ECG-LVH in steady state chronic hemodialysis black patients. Methods: From March 31 to September 30, 2018, interdialytic ABPM was performed after a
mid-week hemodialysis session for 24 hours using a Spacelab 90207 ABPM monitor
in the non-access arm in 45 stable chronic hemodialysis black patients (age ≥20 years, hemodialysis for
at least 3 months and informed consent) attending 3 hemodialysis centers in
Kinshasa. Ambulatory BP was recorded every 20 minutes during the day (6 AM to
10 PM) and every 30 minutes during the night (10PM to 6 AM). ECG-LVH was defined using Cornell
product criteria. ROC curve method was used to assess the performance of
dialysis unit BPs vs. interdialytic 24-hours ABPM in diagnosing ECG-LVH. P<0.05
defined the level of statistical significance. Results: Whatever the
method of BP measurement, all the SBP values were related to ECG-LVH with
similar AUC and overlapping 95%CI;
however, they were not significantly different from each other. 24-hours
interdialytic ambulatory SBP (AUC 0.748; 95%
References
[1]
Agarwal, R. (2010) Blood Pressure and Mortality among Hemodialysis Patients. Hy-pertension, 55, 762-768. https://doi.org/10.1161/HYPERTENSIONAHA.109.144899
[2]
Rohrscheib, M.R., Myers, O.B., Servilla, K.S., et al. (2008) Age-Related Blood Pres-sure Patterns and Blood Pressure Variability among Hemodialysis Patients. Clinical Journal of the American Society of Nephrology, 3, 1407-1414. https://doi.org/10.2215/CJN.00110108
[3]
Agarwal, R. and Lewis, R.R. (2001) Prediction of Hypertension in Chronic Hemodial-ysis Patients. Kidney International, 60, 1982-1989. https://doi.org/10.1046/j.1523-1755.2001.00997.x
[4]
Agarwal, R., Andersen, M.J., Bishu, K. and Saha, C. (2006) Home Blood Pressure Monitoring Improves the Diagnosis of Hypertension in Hemodialysis Patients. Kidney International, 69, 900-906. https://doi.org/10.1038/sj.ki.5000145
[5]
Agarwal, R., Peixoto, A.J., Santos, S.F. and Zoccali, C. (2006) Pre and Post Dialysis Blood Pressures Are Imprecise Estimates of Interdialytic Ambulatory Blood Pressure. Clinical Journal of the American Society of Nephrology, 1, 389-398. https://doi.org/10.2215/CJN.01891105
[6]
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 Ventricu-lar Hypertrophy. Hypertension, 47, 62-68. https://doi.org/10.1161/01.HYP.0000196279.29758.f4
[7]
Nlandu, Y., Lepira, F., Makulo, J.R., et al. (2017) Reverse Epidemiology of Elevated Blood Pressure among Chronic Hemodialysis Black Patients with Stroke: A Historical Cohort Study. BMC Nephrology, 18, 277. https://doi.org/10.1186/s12882-017-0697-0
[8]
Casale, P.N., Devereux, R.B., Kligfield, P., et al. (1985) Electrocardiographic Detection of Left Ventricular Hypertrophy Development and Prospective Validation of Improved Criteria. Journal of the American College of Cardiology, 6, 572-580.
[9]
Agarwal, R., Flynn, J., Pogue, V., et al. (2014) Assessment and Management of Hy-pertension in Patients on Dialysis. Journal of the American Society of Nephrology, 25, 1630-1646. https://doi.org/10.1681/ASN.2013060601
[10]
Agarwal, R. (2010) Managing Hypertension Using Home Blood Pressure Monitoring among Hemodialysis Patients. A Call for Action. Nephrology Dialysis Transplanta-tion, 25, 1766-1711. https://doi.org/10.1093/ndt/gfq171
[11]
Georgianos, P.I. and Agarwal, R. (2017) Blood Pressure in Hemodialysis: Targets? Current Opinion in Nephrology and Hypertension, 26, 523-529. https://doi.org/10.1097/MNH.0000000000000359
[12]
Nassiri, A.A., Lotfollahi, L., Behzadonia, N., et al. (2018) Blood Pressure Measure-ment and Left Ventricular Mass Index in Hemodialysis. Comparison of Several Meth-ods. Iranian Journal of Kidney Diseases, 12, 185-189.
[13]
Rahman, M., Griffin, V., Kumar, A., et al. (2002) A Comparison of Standardized ver-sus “Usual” Blood Pressure Measurements in Hemodialysis Patients. American Jour-nal of Kidney Diseases, 39, 1226-1230. https://doi.org/10.1053/ajkd.2002.33395
[14]
Khangura, J., Culleton, B.F., Manns, B.J., et al. (2010) Association between Routine and Standardized Blood Pressure Measurements and Left Ventricular Hypertrophy among Patients on Hemodialysis. BMC Nephrology, 11, 13. https://doi.org/10.1186/1471-2369-11-13 http://www.biomedcentral.com/1471-2369/11/13
[15]
Yoon, I.C., Choi, H.M. and Oh, D.J. (2017) Which Dialysis Unit Blood Pressure Is the Most Accurate for Predicting Home Blood Pressure in Patients Undergoing He-modialysis? The Korean Journal of Internal Medicine, 32, 117-124. https://doi.org/10.3904/kjim.2015.278
[16]
Van Buren, P.N., Toto, R. and Inrig, J.K. (2011) Intradialytic Hypertension and the Association with Interdialytic Ambulatory Blood Pressure. Clinical Journal of the American Society of Nephrology, 6, 1684-1691. https://doi.org/10.2215/CJN.11041210