Intradialysis hypertension: Focus at high dialysis clearance of antihypertensive medicines


DOI: https://dx.doi.org/10.18565/therapy.2023.3.28-35

Tokareva A.S., Borovkova N.Yu., Lineva N.Yu., Mazhukhina A.A., Mironov M.A.

1) Privolzhsky Research Medical University of the Ministry of Healthcare of Russia, Nizhny Novgorod; 2) N.A. Semashko Nizhny Novgorod Regional Clinical Hospital
Abstract. Presence of intradialysis hypertension (IDH) could be considered as an independent risk factor for total and cardiovascular mortality in dialysis patients. Decrease of concentration of highly dialyzable antihypertensive medicines during hemodialysis session is considered to be one of the pathophysiological mechanisms for increasing intradialysis blood pressure.
The aim of the research is to study the nature of antihypertensive therapy in hemodialysis patients, to assess the IDH frequency and to identify the most significant predictors of its development.
Material and methods. A retrospective study of 131 outpatient cards of dialysis patients was carried out. Data of performing medicamentous therapy were recorded with an emphasis on the dialyzability of the medicines used. Statistical analysis was performed using the IBM SPSS Statistics 26 application package.
Results. IDH occurred in 60% of dialysis patients and was associated with the use of beta-blockers (p=0,015), moxonidine (p=0,001), and highly dialysable medicines (p <0,0001). In multifactor model, the use of beta-blockers has lost its significance, giving way to highly dialysable antihypertensive medicines and moxonidine.
Conclusion. Analysis of the characteristics of drug therapy demonstrated the predominance of highly dialyzable medicines in the treatment of patients at hemodialysis. Use of medicines with high dialysis clearance was associated with an increased IDH incidence (OR 5,585; 95% CI: 2,49–12,54; p <0,0001).
Keywords: dialysis clearance, intradialysis hypertension, moxonidine, hemodialysis, beta-blockers
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Literature

1. US Renal Data System. USRDS 2018 Annual data report: Atlas of chronic kidney disease and end-stage renal disease in the United States. Bethesda, MD: National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. 2018; 2: 228.


2. Андрусев А.М., Перегудова Н.Г., Шинкарев М.Б., Томилина Н.А. Заместительная почечная терапия хронической болезни почек 5 стадии в Российской Федерации 2016–2020 гг. Краткий отчет по данным Общероссийского Регистра заместительной почечной терапии Российского диализного общества. Нефрология и диализ. 2022; 24(4): 555–565. [Andrusev A.M., Peregudova N.G., Shinkarev M.B., Tomilina N.A. Kidney replacement therapy for end stage kidney disease in Russian Federation, 2016–2020. Russian National Kidney Replacement Therapy Registry report of Russian public organization of nephrologists «Russian Dialysis Society». Nefrologiya i dializ = Nephrology and Dialysis. 2022; 24(4): 555–565 (In Russ.)]. https://dx.doi.org/10.28996/2618-9801-2022-4-555-565. EDN: RBZZBH.


3. Georgianos P.I., Agarwal R. Epidemiology, diagnosis and management of hypertension among patients on chronic dialysis. Nat Rev Nephrol. 2016; 12(10): 636–47. https://dx.doi.org/10.1038/nrneph.2016.129.


4. Van Buren P.N., Inrig J.K. Special situations: Intradialytic hypertension/chronic hypertension and intradialytic hypotension. Semin Dial. 2017; 30(6): 545–52. https://dx.doi.org/10.1111/sdi.12631.


5. Shamir A.R., Karembelkar A., Yabes J. et al. Association of intradialytic hypertension with left ventricular mass in hypertensive hemodialysis patients enrolled in the blood pressure in dialysis (BID). Kidney Blood Press Res. 2018; 43(3): 882–92. https://dx.doi.org/10.1159/000490336.


6. Van Buren P.N., Kim C., Toto R.D., Inrig J.K. The prevalence of persistent intradialytic hypertension in a hemodialysis population with extended follow-up. Int J Artif Organs. 2012; 35(12): 1031–38. https://dx.doi.org/10.5301/ijao.5000126.


7. Assimon M.M., Flythe J.E. Intradialytic blood pressure abnormalities: The highs, the lows and all that lies between. Am J Nephrol. 2015; 42(5): 337–50. https://dx.doi.org/10.1159/000441982.


8. Yang C.Y., Yang W.C., Lin Y.P. Postdialysis blood pressure rise predicts long-term outcomes in chronic hemodialysis patients: A four-year prospective observational cohort study. BMC Nephrol. 2012; 13: 12. https://dx.doi.org/10.1186/1471-2369-13-12.


9. Nongnuch A., Campbell N., Stern E. et al. Increased postdialysis systolic blood pressure is associated with extracellular overhydration in hemodialysis outpatients. Kidney Int. 2015; 87(2): 452–57. https://dx.doi.org/10.1038/ki.2014.276.


10. Georgianos P.I., Sarafidis P.A., Zoccali C. Intradialysis hypertension in end-stage renal disease patients: Clinical epidemiology, pathogenesis, and treatment. Hypertension. 2015; 66(3): 456–63. https://dx.doi.org/10.1161/HYPERTENSIONAHA.115.05858.


11. Rubinger D., Backenroth R., Sapoznikov D. Sympathetic activation and baroreflex function during intradialytic hypertensive episodes. PLoS One. 2012; 7(5): e36943. https://dx.doi.org/10.1371/journal.pone.0036943.


12. Teng J., Tian J., Lv W.L. et al. Inappropriately elevated endothelin-1 plays a role in the pathogenesis of intradialytic hypertension. Hemodial Int. 2015; 19(2): 279–86. https://dx.doi.org/10.1111/hdi.12238.


13. Inrig J.K., Van Buren P.N., Kim C. et al. Intradialytic hypertension and its association with endothelial cell dysfunction. Clin J Am Soc Nephrol. 2011; 6(8): 2016–24. https://dx.doi.org/10.2215/CJN.11351210.


14. 1Van Buren P.N. Pathophysiology and implications of intradialytic hypertension. Curr Opin Nephrol Hypertens. 2017; 26(4): 303–10. https://dx.doi.org/10.1097/MNH.0000000000000334.


15. 2018 Dialysis of drugs. Michigan USA: University of Michigan College of Pharmacy Renal Pharmacy Consultants LLC Saline; 2018.


16. Agarwal R., Weir M.R. Dry-weight: A concept revisited in an effort to avoid medication-directed approaches for blood pressure control in hemodialysis patients. Clin J Am Soc Nephrol. 2010; 5(7): 1255–60. https://dx.doi.org/10.2215/CJN.01760210.


17. Sinha A.D., Agarwal R. Can chronic volume overload be recognized and prevented in hemodialysis patients? The pitfalls of the clinical examination in assessing volume status. Semin Dial. 2009; 22(5): 480–82. https://dx.doi.org/10.1111/j.1525-139X.2009.00641.x.


18. Зелтынь-Абрамов Е.М., Земченков А.Ю. Артериальная гипертензия при ХБП: от начальных до продвинутых стадий. Диагностические и терапевтические стратегии. Часть 2. Заместительная почечная терапия (программный гемодиализ). Нефрология и диализ. 2020; 22(2): 237–251. [Zeltyn-Abramov E.M., Zemchenkov A.Yu. Hypertension and chronic kidney disease: from initial to advanced stages. Diagnostic and therapeutic strategies. Part 2. Renal replacement therapy (maintenance hemodialysis). Nefrologiya i dializ = Nephrology and Dialysis. 2020; 22(2): 237–251 (In Russ.)]. https://dx.doi.org/10.28996/2618-9801-2020-2-237-251. EDN: WFTJZE.


19. Sarafidis P.A., Persu A., Agarwal R. et al. Hypertension in dialysis patients: A consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis and Trans- plant Association (ERA-EDTA) and the Hypertension and the Kidney Working Group of the European Society of Hypertension (ESH). Nephrol Dial Transplant. 2017; 32(4): 620–24. https://dx.doi.org/10.1093/ndt/gfw433.


20. Lemes H.P., Araujo S., Nascimento D. et al. Use of small doses of furosemide in chronic kidney disease patients with residual renal function undergoing hemodialysis. Clin Exp Nephrol. 2011; 15(4): 554–59. https://dx.doi.org/10.1007/s10157-011-0427-z.


21. Sibbel S., Walker A.G., Colson C. et al. Association of continuation of loop diuretics at hemodialysis initiation with clinical outcomes. Clin J Am Soc Nephrol. 2018; 14(1): 95–102. https://dx.doi.org/10.2215/CJN.05080418.


22. Bragg-Gresham J.L., Fissell R.B., Mason N.A. et al. Diuretic use, residual renal function, and mortality among hemodialysis patients in the Dialysis Outcomes and Practice Pattern Study (DOPPS). Am J Kidney Dis. 2007; 49(3): 426–31. https://dx.doi.org/10.1053/j.ajkd.2006.12.012.


23. Kramer H.J., Townsend R.R., Griffin K. et al. KDOQI US commentary on the 2017 ACC/AHA hypertension guideline. Am J Kidney Dis. 2019; 73(4): 437–58. https://dx.doi.org/10.1053/j.ajkd.2019.01.007.


24. akahashi A., Takase H., Toriyama T. et al. Candesartan, an angiotensin II type-1 receptor blocker, reduces cardiovascular events in patients on chronic haemodialysis – a randomized study. Nephrol Dial Transplant. 2006; 21(9): 2507–12. https://dx.doi.org/10.1093/ndt/gfl293.


25. Iseki K., Arima H., Kohagura K. et al. Effects of angiotensin receptor blockade (ARB) on mortality and cardiovascular outcomes in patients with long-term haemodialysis: A randomized controlled trial. Nephrol Dial Transplant. 2013; 28(6): 1579–89. https://dx.doi.org/10.1093/ndt/gfs590.


26. Tepel M., Hopfenmueller W., Scholze A. et al. Effect of amlodipine on cardiovascular events in hypertensive haemodialysis patients. Nephrol Dial Transplant. 2008; 23(11): 3605–12. https://dx.doi.org/10.1093/ndt/gfn304.


27. Weir M.A., Dixon S.N., Fleet J.L. et al. β-Blocker dialyzability and mortality in older patients receiving hemodialysis. J Am Soc Nephrol. 2015; 26(4): 987–96. https://dx.doi.org/10.1681/ASN.2014040324.


28. Weir M.A., Fleet J.L., Dixon S.N. et al. Angiotensin converting enzyme inhibitor dialyzability and outcomes in older patients receiving hemodialysis. Blood Purif. 2015; 40(3): 232–42. https://dx.doi.org/10.1159/000438821.


29. Assimon M.M., Brookhart M.A., Fine J.P. et al. A comparative study of carvedilol versus metoprolol initiation and 1-year mortality among individuals receiving maintenance hemodialysis. Am J Kidney Dis. 2018; 72(3): 337–48. https://dx.doi.org/10.1053/j.ajkd.2018.02.350.


About the Autors

Anastasia S. Tokareva, assistant at the Department of hospital therapy and general medical practice named after V.G. Vogralik, Privolzhsky Research Medical University of the Ministry of Healthcare of Russia. Address: 603005, Nizhny Novgorod, 10/1 Minina and Pozharskogo Sq. E-mail: toktokareva@gmail.com.
ORCID: https://orcid.org/0000-0003-0640-6848
Natalya Yu. Borovkova, MD, associate professor, professor of the Department of hospital therapy and general medical practice named after V.G. Vogralik, Privolzhsky Research Medical University of the Ministry of Healthcare of Russia. Address: 603005, Nizhny Novgorod, 10/1 Minina and Pozharskogo Sq. E-mail: borovkov-nn@mail.ru. ORCID: https://orcid.org/0000-0001-7581-4138
Natalya Yu. Lineva, head of the Department of dialysis and gravitational blood surgery, N.A. Semashko Nizhny Novgorod Regional Clinical Hospital. Address: 603126, Nizhny Novgorod, 190 Rodionova Str. E-mail: lineva_natalja@rambler.ru. ORCID: https://orcid.org/0000-0002-2900-5986
Alina A. Mazhukhina, 6th year student of the Faculty of general medicine, Privolzhsky Research Medical University of the Ministry of Healthcare of Russia. Address: 603005, Nizhny Novgorod, 10/1 Minina and Pozharskogo Sq. E-mail: kudryashovamargo@yandex.ru
Mikhail A. Mironov, 6th year student of the Faculty of general medicine, Privolzhsky Research Medical University of the Ministry of Healthcare of Russia. Address: 603005, Nizhny Novgorod, 10/1 Minina and Pozharskogo Sq. E-mail: mironovdoctor@gmail.com


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