Mujtaba Farah, Qureshi Ruqaya, Dhrolia Murtaza, Nasir Kiran, Ahmad Aasim
Nephrology, The Kidney Centre Post Graduate Training Institute, Karachi, PAK.
Cureus. 2022 Dec 29;14(12):e33104. doi: 10.7759/cureus.33104. eCollection 2022 Dec.
To estimate the frequency of intradialytic hypertension (IDH) in our centre as per the definition suggested by Kidney Disease: Improving Global Outcomes (KDIGO).
A cross-sectional study was conducted at the dialysis department of The Kidney Centre Post Graduate Training Institute (PGTI) Karachi, Pakistan from August 2021 to October 2021 among 263 end-stage kidney disease (ESKD) patients on maintenance hemodialysis (MHD) aged ≥ 18 years of both genders. The study outcome was the frequency of IDH as per the latest KDIGO suggested definition i.e., systolic blood pressure (SBP) rise of > 10 mm Hg from pre- to post-dialysis within the hypertensive range in at least four out of six consecutive dialysis treatments. Frequencies (%) and mean (±SD) were calculated for categorical and continuous variables respectively, using SPSS version 21 (IBM Corp., Armonk, NY, USA).
Among 263 patients, the mean age was 51.02 (±14.1) years and 56.3% were males. Around 30.8% of patients were dialysis-dependent for 1.1 to three years. The most common comorbidity was hypertension (88.6%). Standard dialysate calcium of 3mEq/l was received by 91.6% of study participants. About 78.7% of patients were using antihypertensive(s), out of which 85.5% were compliant and 37.6% were using a single antihypertensive. The most common antihypertensive in use was beta-blockers (78.3%). Around 16% of patients were found to have IDH. Age of the patients was significantly associated with IDH (p=0.038). The majority of the patients with IDH were those who were taking anti-hypertension medications as compared to the patients who were not taking them (p <0.004). Interdialytic weight gain was not a significant predictor for IDH.
The frequency of IDH was 16% according to the latest suggested KDIGO definition. This is much lower than regional and global estimates according to earlier definitions. There is a dire need to establish a standardized definition of IDH in guidelines to diagnose, manage and compare data. Also, the association of IDH with fluid overload is not found in our study which emphasizes the need to evaluate other causative factors.
根据改善全球肾脏病预后组织（KDIGO）建议的定义，评估我院中心透析期间高血压（IDH）的发生率。
2021年8月至2021年10月，在巴基斯坦卡拉奇肾脏中心研究生培训学院（PGTI）透析科对263例年龄≥18岁、接受维持性血液透析（MHD）的终末期肾病（ESKD）患者进行了一项横断面研究，研究对象包括不同性别的患者。研究结果是根据KDIGO最新建议的定义得出的IDH发生率，即在连续六次透析治疗中，至少有四次在高血压范围内透析前至透析后收缩压（SBP）升高>10mmHg。分别使用SPSS 21版（美国纽约州阿蒙克市IBM公司）计算分类变量和连续变量的频率（%）和均值（±标准差）。
263例患者中，平均年龄为51.02（±14.1）岁，男性占56.3%。约30.8%的患者依赖透析1.1至三年。最常见的合并症是高血压（88.6%）。91.6%的研究参与者接受3mEq/l的标准透析液钙。约78.7%的患者使用抗高血压药物，其中85.5%的患者依从，37.6%的患者使用单一抗高血压药物。使用最多的抗高血压药物是β受体阻滞剂（78.3%）。约16%的患者被发现患有IDH。患者年龄与IDH显著相关（p=0.038）。与未服用抗高血压药物的患者相比，大多数患有IDH的患者正在服用抗高血压药物（p<0.004）。透析间期体重增加不是IDH的显著预测因素。
根据KDIGO最新建议的定义，IDH的发生率为16%。这远低于根据早期定义得出的区域和全球估计值。迫切需要在指南中建立IDH的标准化定义，以诊断、管理和比较数据。此外，本研究未发现IDH与液体超负荷之间的关联，这强调了评估其他致病因素的必要性。
