SP546PREDICTORS OF INTRADIALYTIC HYPERTENSION IN CHRONIC END STAGE RENAL DIALYSIS PATIENTS IN A TERTIARY HOSPITAL IN DAVAO CITY

Abstract

INTRODUCTION AND AIMS: Patients on chronic maintenance dialysis have an alarmingly high mortality of approximately 15-20% . This rate is mainly due to cardiovascular comorbidity and, secondarily in part to the the increasing prevalence of changes in blood pressure. These blood pressure changes are the most common complications that occur in these patients, most commonly hypotension, with intradialytic hypertension (IDH) occurring second. This study aims to investigate on (a) the prevalence of IDH and (b) determine the demographic, clinical profile and modifiable factors which can predict the occurrence of IDH. METHODS: The study is a single center government-owned tertiary hospital based prospective observational cohort, research study. Three hundred thirty two (332) patients enrolled at the centre were included in the study, with only 307 giving consent. All patients were then subjected to a bioimpedance monitor to gather data on fluid levels both intra and extra cellular levels, urea content and tissue and adipose masses. DH for this study was defined as≥10 mmHg rise in the SBP between pre-and post-dialysis in at least four of six consecutive dialysis sessions. The subjects were then distributed into two groups: with and without IDH. Laboratory results and other significant information was gathered from the charts of the subjects that were taken from the records of the dialysis unit. Continuous variables were expressed as mean6SD while categoricalvariables were noted as frequency and percentage. The paired t-test was then applied for continuous variables such as age, gender, duration of dialysis, aver-age ultrafiltrate volume, Mean Arterial Pressure, Mean Heart Rate, Use of Ery-thropoietin, Total Fluid Overload and Co-morbid illness) , while the chi-squared test was used for categorical variables to assess the association. These were then analyzed using an univariate analysis. The significant factors were then further analyzed by using the multivariate analysis where the continuous vari-ables were dichotomously categorized. Values of P< 0.05 will be considered statistically significant. RESULTS: Incidence of IDH in the study was at 37% which was higher as compared to the worldwide rate of 5-15% as well as to studies made in India, Nigeria and South Africa at 34.51%, 31% and 28% prevalences respectively. Males are significantly greater than women in the prevalence of IDH. Presence of hypertension as a comorbid is significantly higher in the IDH than in the non IDH group. Among the modifiable factors, serum albumin levels, ultrafiltrate volumes, mean heart rate and arterial pressures showed significant difference between theWOHand WIH. Results from the bioimpedance monitor likewise showed that the volumes of total fluid, extracellular water and intracellular water, levels of urea content and masses of adipose tissue and lean tissue were significantly higher in those with IDH. CONCLUSIONS: Using a logistic regression analysis, results revealed that those with the highest odds ratio in predicting the onset of IDH were ultrafiltrate volumes, serum albumin levels and intradialytic hypotension. The high incidence of IDH should serve as an alarm to the institution. Measures should be taken to reduce its incidence by modifying certain practice that are already used to reduce its presence in hemodialysis patients and preventing more morbid complications like death.