Incidence and Predictive Factors of Intradialytic Hypertension in Patients Undergoing Hemodialysis? An Observational Study from North India

Background: Cardiovascular issue associated with hemodialysis is intradialytic hypertension (IDH), affecting approximately 15% of patients. To enhance our comprehension of IDH, study sought to ascertain its incidence and identify factors that predict its development in hemodialysis patients. Methods: An observational study was carried out in 174 patients over the age of 18 years, undergoing hemodialysis at least twice a week for at least three months. IDH was defined as systolic BP increase of ≥10 mm Hg occurring during dialysis, starting after the first hour and continuing for at least 30 minutes after the session’s completion, observed in at least 4 out of 6 successive dialysis sessions. Blood tests including CBC, and KFT were performed before dialysis. ECHO-2D was conducted at baseline. BP, pulse rate, and Mean Arterial Pressure were monitored hourly and 30 minutes post-dialysis. Four-electrode BIA device (Fresenius, Germany) utilized for assessment of hydration status. Patients were categorized into two groups - IDH-group A and non-IDH group B. Results: The incidence of IDH was 34.5%, with half of patients being male and average age was 55.4±15 years. The non-IDH group B (65.5%) consisted of 58.7% males, with mean age of 57.3±12.8 years. The most common cause of ESKD in both groups was chronic glomerulonephritis, accounting for 55% of group A and 44.7% of group B. Hypertension (86.7%) and diabetes (48.8%) were prevalent in both groups. A negative correlation was found between IDH and BMI (r-0.16,p0.037), and hemoglobin levels (r-0.21,p0.006). IDH was positively correlated with Hydration status(r0.19,p0.011), left ventricular hypertrophy (LVH) (r0.16,p0.034), and number of antihypertensive medications (r0.3,p0.01), particularly ACE/ARB use (r0.39,p0.01). The multivariate analysis revealed that hydration status (p0.037), LVH (p0.04), and ACE/ARB use (p0.02) were independent predictors of IDH. Conclusion: Almost one-third of patients with hemodialysis experience IDH, which is a clinically relevant phenomenon. The risk factors associated with IDH include hydration status, LVH, and the use of ACEi/ARB.