An intradialytic blood pressure assessment extended by two weeks predicts cardiovascular events with an accuracy comparable to that of home blood pressure measurements among hemodialysis patients
Abstract
Introduction. Pressure measurements obtained before and after hemodialysis (HD) are marked by their high variability and poor reliability, which undermine their ability to estimate cardiovascular events (CVs).
Objective. This study sought to determine whether more measurements performed over a longer period of time enable a more accurate evaluation of the CVs associated with arterial hypertension.
Material and methods. This study included 40 patients (23 men and 17 women) aged between 27 and 82 years with a mean age of 58.8 } 13.6 years who underwent chronic HD for 4 to 338 months. On days without HD, blood pressure home measurements (HMs) were recorded in the morning, afternoon and evening, and the results were obtained each day for 8 days. Furthermore, pressure measurements were recorded five times during 7 subsequent planned HD procedures: before HD, after HD and three times during HD. After 12 months, the number of CVs was determined with respect to the pressure measurement method. Results. The correlation coefficients between the HMs and HD with regard to systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) were 0.85, 0.80, and 0.84, respectively (P < 0.001). The receiver operating curve (ROC) values for SBP were 137.8 mmHg for HM and 140.4 mmHg for HD. The sensitivity and specificity of the HMs for SBP were 0.667 and 0.727, respectively. CVs occurred in 66.7% of the patients with SBPs ≥ 137.8 mmHg. The sensitivity and specificity of the HD measurements of SBP were 0.611 and 0.818, respectively. CVs occurred in 73.3% of patients with SBPs ≥ 140.4 mmHg. Conclusions. Increasing the number of pressure measurements over a longer period of time in patients with HD likely improves the reliability of CV risk estimates.
Keywords: cardiovascular eventshemodialysishemodialysis unit blood pressure measurementshome blood pressure measurements
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