Introduction:
The prevalence of chronic kidney disease is approximately 10% of the global population [1]. Chronic kidney disease (CKD) is the most common cause of secondary hypertension, in which hypertension is considered an important co-morbid factor associated with CKD and is the leading cause of death globally [2]. Hypertension presents in approximately 80–85% of patients with CKD[3]KDIGO criteria for blood pressure (BP) for control of BP in maintenance hemodialysis (MHD) is <140/90 mm of Hg. It has been found that about 30% of patients have well-controlled HTN, while 56% were uncontrolled (4). We looked at the control of blood pressure amongst CKD on haemodialysis in our centre.
Methods:
Single-centre cross-sectional study, enrolling ESKD undergoing MHD patients undergoing dialysis at R.L Jalappa Hospital, Tamaka, Kolar, the only tertiary care centre in the district. Demography, comorbidity status, relevant history, and laboratory information were collected from Jan to June 2024 prospectively for the study. All patients above 16 years, and who had undergone continuous dialysis for at least one month were included in the study. A total of 100 patients were found eligible and were included in the study. The patients underwent 4 hour hemodialysis twice/thrice weekly. BP recordings taken were a mean of home BP recordings and intradialytic and postdialytic measurements. The estimated sample size was 80 with a 95 % confidence interval. The study was approved by the Institutional Ethics Committee.
Statistical analysis:
After testing for normality of the data by Shapiro-Wilk test and Q-Q plot, descriptive statistics like percentage, mean and standard deviation were applied. Demographic parameters like age, gender, comorbidities, dialysis vintage (months), and dialysis frequency (per week) were expressed as mean +/- S.D. Variables included were mean blood pressure , dry weight , and antihypertensives (number and type) used were expressed as mean +/- S.D using independent t-tests. P value < 0.05 is considered significant
Results:
Results: Are mentioned in table 1, 2, 3
The mean age of patients was 50.69±14.45 years with 2/3 rd of patients being male. About 37% were diabetic, and the average dialysis vintage was 27.4±33.8 months. 30% of patients required polypharmacy with more than 3 drugs for control. Calcium channel blockers were used in more than 60% of patients as first-line therapy. However, 75% of patients did not achieve the target optimum BP, with stage 1 HTN in 28% and stage 2 in 46 %. Those with uncontrolled BP were more likely to be older in age and diabetic (p<0.05. Nonachievement of target dry weight was the most common reason for poor control of BP.
Table 1: Demographic parameters
Table 2: Usage of antihypertensive
Fig 1: Pie chart of antihypertensives used for control
Table 3: BP control as defined by JNC-8 criteria
Conclusions:
In our preliminary single-center audit of blood pressure control in maintenance hemodialysis patients, we found that a significant number of patients(75%) had uncontrolled BP with nonachievement of target dry weight as a contributing factor. Most patients required 1-3 drugs for optimum control. Patient compliance with adherence to salt restriction and dialysis procedure will be integral if HTN related cardiovascular morbidity and mortality has to be reduced in this population.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.