Prediction Models of Intradialytic Hypertension: The Role of Arterial Stiffness Parameters

Abstract

Study Objective: To define the predictive value of arterial stiffness parameters in the development of intradialytic hypertension (IDH) in patients undergoing long-term HD. Study Design: Prospective study. Material and Methods. The prospective study included 45 patients undergoing long-term HD. An IDH criterion was an increase in systolic blood pressure >10 mm Hg after the HD in more than 4 out of 6 sessions during the period preceding 24-hour blood pressure monitoring (24BPM). Arterial stiffness parameters were assessed using a Vasotens-24 BPLab software package (by Peter Telegin, Russia). We recorded the demographics of patients and physical examination results, lab test results, duration of HD, concomitant cardiovascular diseases, and medications taken. For data analysis we used Statistics 26 application package (IBM SPSS). Study Results. The mean age of patients was 51 [41; 61] years old; HD duration was 4.5 [1.1; 7.8] years. IDH was recorded in 20 patients; the multivariate correlation analysis showed that IDH was associated with the patients’ age (HR = 3.78; 95% CI 1.29–11.04), with the augmentation index AIx (HR = 7.75; 95% CI 2.65–22.7). Inverse correlation was observed between IDH development and reflection wave transmission time — RWTT100–60 (HR = 0.27; 95% CI 0.14–0.53), presence of diabetic nephropathy (HR = 0.34; 95% CI 0.094–1.251), residual diuresis (HR = 0.43; 95% CI 0.21–0.87), and albumin level (HR = 0.12; 95% CI 0.02–0.79). Inclusion of arterial stiffness parameters into the mathematical model increased its predictive ability from AUC = 0.886 to AUC = 0.978. Conclusion. In this study, AIx ≥ –6.5% and RWTT100–60 ≤ 134.5 m/s were associated with a higher frequency of IDH, which can be a sign of the leading role of progressive artery stiffness in the development of intradialytic cardiovascular complications. Keywords: hemodialysis, intradialytic hypertension, arterial stiffness.