Aims: This study was aimed at comparing the incidence of arterial hypertension and blood pressure (BP) variance in hospital and out-of-hospital hemodialysis (HD) patients during HD sessions. Methods: A cross-sectional study was conducted for 1 week at all the HD centers in Dalmatia, Croatia. The pre-, intra-, and post-dialysis BP values were collected for 3 consecutive HD sessions per patient. Results: Of the 399 subjects, 73.9% were hypertensives, who showed higher interdialytic weight gain compared to the normotensives (2.58 vs. 2.40). Hospital and out-of-hospital HD patients received identical antihypertensive therapies, except that beta blockers were more frequently administered to out-of-hospital HD patients. Higher pre-, intra-, and post-dialysis BP values were recorded in patients at out-of-hospital HD centers. Conclusion: The differences in BP variability and antihypertensive therapies administered to hospital HD patients as compared to out-of-hospital HD patients may reflect differing approaches by the nephrologists at these centers.

Keywords:
Blood pressure, Antihypertensives, Hemodialysis, Arterial hypertension
1.
Mittal SK, Kowalski E, Trenkle J, McDonough B, Halinski D, Devlin K, Boylan E, Flaster E, Maesaka JK: Prevalence of hypertension in a hemodialysis population. Clin Nephrol 1999;51:77-82.
2.
Grekas D, Bamichas G, Bacharaki D, Goutzaridis N, Kasimatis E, Tourkantonis A: Hypertension in chronic hemodialysis patients: current view on pathophysiology and treatment. Clin Nephrol 2000;53:164-168.
3.
Charra B, Jean G, Chazot C, Hurot JM, Terrat JC, Vanel T, Lorriaux C, Vovan C: Intensive dialysis and blood pressure control: a review. Hemodial Int 2004;8:51-60.
4.
Pavlovic D, Heinrich B, Germin-Petrovic D, Pavlovic N: [Arterial hypertension in patients on long-term haemodialysis]. Lijec Vjesn 2006;128:381-384.
5.
Del Vecchio L, Lusenti T, Del Rosso G, Malandra R, Balducci A, Losito A; Group for Arterial Hypertension of the Italian Society of Nephrology: Prevalence of hypertension in a large cohort of Italian hemodialysis patients: results of a cross-sectional study. J Nephrol 2013;26:745-754.
6.
Kidney Disease Outcomes Quality Initiative (K/DOQI): K/DOQI clinical practice guidelines on hypertension and antihypertensive agents in chronic kidney disease. Am J Kidney Dis 2004;43(5 suppl 1):S1-S290.
7.
Alborzi P, Patel N, Agarwal R: Home blood pressures are of greater prognostic value than hemodialysis unit recordings. Clin J Am Soc Nephrol 2007;2:1228-1234.
8.
Bishu K, Gricz KM, Chewaka S, Agarwal R: Appropriateness of antihypertensive drug therapy in hemodialysis patients. Clin J Am Soc Nephrol 2006;1:820-824.
9.
Mancia G, Fagard R, Narkiewicz K, Redón J, Zanchetti A, Böhm MChristiaens T, Cifkova R, De Backer G, Dominiczak A, Galderisi M, Grobbee DE, Jaarsma T, Kirchhof P, Kjeldsen SE, Laurent S, Manolis AJ, Nilsson PM, Ruilope LM, Schmieder RE, Sirnes PA, Sleight P, Viigimaa M, Waeber B, Zannad F: 2013 ESH/ESC guidelines for the management of arterial hypertension: the task force for the management of arterial hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens 2013;31:1281-1357.
10.
Soliman RA, Fawzy M, Kandil H, el Fattah AA: Assessment of hypotension during dialysis as a manifestation of myocardial ischemia in patients with chronic renal failure. Egypt J Crit Care Med 2014;2:13-19.
11.
Agarwal R, Nissenson AR, Batlle D, Coyne DW, Trout JR, Warnock DG: Prevalence, treatment, and control of hypertension in chronic hemodialysis patients in the United States. Am J Med 2003;115:291-297.
12.
Agarwal R, Peixoto AJ, Santos SF, Zoccali C: Pre- and postdialysis blood pressures are imprecise estimates of interdialytic ambulatory blood pressure. Clin J Am Soc Nephrol 2006;1:389-398.
13.
Rahman M, Fu P, Sehgal AR, Smith MC: Interdialytic weight gain, compliance with dialysis regimen, and age are independent predictors of blood pressure in hemodialysis patients. Am J Kidney Dis 2000;35:257-265.
14.
Levin NW, Kotanko P, Eckardt KU, Kasiske BL, Chazot C, Cheung AK, Redon J, Wheeler DC, Zoccali C, London GM: Blood pressure in chronic kidney disease stage 5D-report from a kidney disease: improving global outcomes controversies conference. Kidney Int 2009;77:273-284.
15.
Rocco MV, Yan G, Heyka RJ, Benz R, Cheung AK; HEMO Study Group: Risk factors for hypertension in chronic hemodialysis patients: baseline data from the HEMO Study. Am J Nephrol 2001;21:280-288.
16.
Weir MA, Dixon SN, Fleet JL, Roberts MA, Hackam DG, Oliver MJ, Suri RS, Quinn RR, Ozair S, Beyea MM, Kitchlu A, Garg AX: β-Blocker dialyzability and mortality in older patients receiving hemodialysis. J Am Soc Nephrol 2015;26:987-996.
17.
Weir MA, Fleet JL, Dixon SN, Jain AK, Oliver M, Wald R, McIntyre C, Garg AX: Angiotensin converting enzyme inhibitor dialyzability and outcomes in older patients receiving hemodialysis. Blood Purif 2015;40:232-242.
18.
Heerspink HJ, Ninomiya T, Zoungas S, de Zeeuw D, Grobbee DE, Jardine MJ, Gallagher M, Roberts MA, Cass A, Neal B, Perkovic V: Effect of lowering blood pressure on cardiovascular events and mortality in patients on dialysis: a systematic review and meta-analysis of randomised controlled trials. Lancet 2009;373:1009-1015.
19.
Agarwal R, Sinha AD: Cardiovascular protection with antihypertensive drugs in dialysis patients: systematic review and meta-analysis. Hypertension 2009;53:860-866.
20.
Kes P, Ljutić D: Cardiovascular risk factors in end-stage renal disease. Acta Med Croat 1998;52:1-10.
21.
Herzog CA, Mangrum JM, Passman R: Sudden cardiac death and dialysis patients. Semin Dial 2008;21:300-307.
22.
Agarwal R: Strategies and feasibility of hypertension control in a prevalent hemodialysis cohort. Clin Nephrol 2000;53:344-353.
23.
Kulkarni MJ, Jamale T, Hase NK, Jagdish PK, Keskar V, Patil H, Shete A, Patil C: A cross-sectional study of dialysis practice-patterns in patients with chronic kidney disease on maintenance hemodialysis. Saudi J Kidney Dis Transpl 2015;26:1050-1056.
24.
Zazgornik J, Biesenbach G, Forstenlehner M, Stummvoll K: Profile of antihypertensive drugs in hypertensive patients on renal replacement therapy (RRT). Clin Nephrol 1997;48:337-440.
25.
Cice G, Ferrara L, D'Andrea A, D'Isa S, Di Benedetto A, Cittadini A, Russo PE, Golino P, Calabro R: Carvedilol increases two-year survivalin dialysis patients with dilated cardiomyopathy: a prospective, placebo-controlled trial. J Am Coll Cardiol 2003;41:1438-1444.
26.
Locatelli F, Bommer J, London GM, Martín-Malo A, Wanner C, Yaqoob M, Zoccali C: Cardiovascular disease determinants in chronic renal failure: clinical approach and treatment. Nephrol Dial Transplant 2001;16:459-468.
27.
Mc Causland FR, Waikar SS, Brunelli SM: Increased dietary sodium is independently associated with greater mortality among prevalent hemodialysis patients. Kidney Int 2012;82:204-211.
28.
Kayikcioglu M, Tumuklu M, Ozkahya M, Ozdogan O, Asci G, Duman S, Toz H, Can LH, Basci A, Ok E: The benefit of salt restriction in the treatment of end-stage renal disease by haemodialysis. Nephrol Dial Transplant 2009;24:956-962.
29.
Titze J, Ritz E: Salt and its effect on blood pressure and target organ damage: new pieces in an old puzzle. J Nephrol 2009;22:177-189.
30.
Kuriyama S, Yokoyama K, Hara Y, Sugano N, Yokoo T, Hosoya T: Effect of aliskiren in chronic kidney disease patients with refractory hypertension undergoing hemodialysis: a randomized controlled multicenter study. Clin Exp Nephrol 2014;18:821-830.
31.
Suzuki R, Honda H, Niikura K, Akizawa T: Olmesartan medoxomil treatment is associated with decreased plasma B-type natriuretic peptide levels in patients on hemodialysis. Clin Exp Hypertens 2012;34:125-131.
32.
Ozkahya M, Ok E, Toz H, Asci G, Duman S, Basci A, Kose T, Dorhout Mees EJ: Long-term survival rates in haemodialysis patients treated with strict volume control. Nephrol Dial Transplant 2006;21:3506-3513.
33.
Charra B, Bergström J, Scribner BH: Blood pressure control in dialysis patients: importance of the lag phenomenon. Am J Kidney Dis 1998;32:720-724.
34.
Luik AJ, v d Sande FM, Weideman P, Cheriex E, Kooman JP, Leunissen KM: The influence of increasing dialysis treatment time and reducing dry weight on blood pressure control in hemodialysis patients: a prospective study. Am J Nephrol 2001;21:471-478.
35.
Charra B, Terrat JC, Vanel T, Chazot C, Jean G, Hurot JM, Lorriaux C: Long thrice weekly hemodialysis: the Tassin experience. Int J Artif Organs 2004;27:265-283.
36.
Luik AJ, Charra B, Katzarski K, Habets J, Cheriex EC, Menheere PP, Laurent G, Bergström J, Leunissen KM: Blood pressure control and hemodynamic changes in patients on long time dialysis treatment. Blood Purif 1998;16:197-209.
37.
Kooistra MP, Vos J, Koomans HA, Vos PF: Daily home haemodialysis in The Netherlands: effects on metabolic control, haemodynamics, and quality of life. Nephrol Dial Transplant 1998;13:2853-2860.
38.
Pinciaroli AR: Results of daily hemodialysis in Catanzaro: 12-year experience with 22 patients treated for more than one year. Home Hemodial Int 1998;2:12-17.
39.
Di Iorio B, Di Micco L, Torraca S, Sirico ML, Guastaferro P, Chiuchiolo L, Nigro F, De Blasio A, Romano P, Pota A, Rubino R, Morrone L, Lopez T, Casino FG: Variability of blood pressure in dialysis patients: a new marker of cardiovascular risk. J Nephrol 2013;26:173-182.
40.
Harvey PR, Holt A, Nicholas J, Dasgupta I: Is an average of routine postdialysis blood pressure a good indicator of blood pressure control and cardiovascular risk? J Nephrol 2013;26:94-100.
41.
Van Buren PN, Toto R, Inrig JK: Interdialytic ambulatory blood pressure in patients with intradialytic hypertension. Curr Opin Nephrol Hypertens 2012;21:15-23.
42.
Oosugi K, Fujimoto N, Dohi K, Machida H, Onishi K, Takeuchi M, Nomura S, Takeuchi H, Nobori T, Ito M: Hemodynamic and pathophysiological characteristics of intradialytic blood pressure elevation in patients with end-stage renal disease. Hypertens Res 2014;37:158-165.
43.
Park J, Rhee CM, Sim JJ, Kim YL, Ricks J, Streja E, Vashistha T, Tolouian R, Kovesdy CP, Kalantar-Zadeh K: A comparative effectiveness research study of the change in blood pressure during hemodialysis treatment and survival. Kidney Int 2013;84:795-802.
44.
Reilly JB, Marcotte LM, Berns JS, Shea JA: Handoff communication between hospital and outpatient dialysis units at patient discharge: a qualitative study. Jt Comm J Qual Patient Saf 2013;39:70-76.
45.
Esposito P, Benedetto AD, Tinelli C, De Silvestri A, Rampino T, Marcelli D, Dal Canton A: Clinical audit improves hypertension control in hemodialysis patients. Int J Artif Organs 2013;36:305-313.
46.
Martino S: Motivational interviewing to engage patients in chronic kidney disease management. Blood Purif 2011;31:77-81.
47.
Kauric-Klein Z: Predictors of nonadherence with blood pressure regimens in hemodialysis. Patient Prefer Adherence 2013;7:973-980.
48.
Harley KT, Streja E, Rhee CM, Molnar MZ, Kovesdy CP, Amin AN, Kalantar-Zadeh K: Nephrologist caseload and hemodialysis patient survival in an urban cohort. J Am Soc Nephrol 2013;24:1678-1687.
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