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Is ambulatory blood pressure monitoring required for elderly hemodialysis patients during the interdialytic period? - Experience of a tertiary care center in South India

 Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), Chennai, Tamil Nadu, India

Correspondence Address:
E Indhumathi,
Associate Professor, Department of Nephrology, Sri Ramachandra Institute of Higher Education and Research (Deemed to be University), No 1, Ramachandra Nagar, Porur, Chennai - 600 116, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijn.IJN_160_20

Introduction: Hypertension (HT) is a common and challenging problem in patients on dialysis. Routine peri-dialytic blood pressure (BP) recordings are unable to diagnose HT accurately and stratify cardiovascular risk. We report here an analysis of 2 years, single-center experience on 24-hour ambulatory blood pressure monitoring (ABPM) in elderly hemodialysis patients in the interdialytic period. Materials and Methods: Data of all the patients above 65 years of age undergoing hemodialysis between November 2017 and December 2019 in our hemodialysis unit and for whom 24-hour ABPM was done were collected. Demographics, clinical profile, pre- and post-dialysis BP recordings, 24-hour ABPM characteristics, and the outcome status were analyzed. Results: Of the 37 patients, 28 (75.7%) were males with a mean age of 67.73 years; 67.6% were diabetic. HT was found in all patients (100%), and uncontrolled HT was noted in 30 (81%) patients by ABPM. Patients with uncontrolled HT were also nondippers of BP (100%). A significant association was observed between nondippers and coronary artery disease (n = 27, 90%, P = 0.004). Masked HT was found in 9 (24.3%) patients with normal peridialytic BP (n = 9, 24.3%, P = 0.000). No significant difference was noted between diabetic and nondiabetic patients regarding dipping status or mortality. Among 37 patients, 9 (24.3%) died during follow-up with uncontrolled HT as a significant risk factor (P = 0.05). Conclusion: The prevalence of uncontrolled HT with blunted circadian rhythm was high as detected by ABPM in the interdialytic period among elderly hemodialysis patients and had a significant impact on mortality. Masked uncontrolled HT as measured by ABPM was not uncommon in patients with normal peridialytic BP.

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Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07