Intradialysis hypertension: Focus at high dialysis clearance of antihypertensive medicines

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Resumo

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).

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Sobre autores

Anastasia Tokareva

Privolzhsky Research Medical University of the Ministry of Healthcare of Russia

Autor responsável pela correspondência
Email: toktokareva@gmail.com
ORCID ID: 0000-0003-0640-6848

Assistant at the Department of Hospital Therapy and General Medical Practice named after V.G. Vogralik

Rússia, Nizhny Novgorod

Natalya Borovkova

Privolzhsky Research Medical University of the Ministry of Healthcare of Russia

Email: borovkov-nn@mail.ru
ORCID ID: 0000-0001-7581-4138

MD, Associate Professor, Professor of the Department of Hospital Therapy and General Medical Practice named after V.G. Vogralik

Rússia, Nizhny Novgorod

Natalya Lineva

N.A. Semashko Nizhny Novgorod Regional Clinical Hospital

Email: lineva_natalja@rambler.ru
ORCID ID: 0000-0002-2900-5986

Head of the Department of Dialysis and Gravitational Blood Surgery

Rússia, Nizhny Novgorod

Alina Mazhukhina

Privolzhsky Research Medical University of the Ministry of Healthcare of Russia

Email: kudryashovamargo@yandex.ru

6th year student of the Faculty of General Medicine

Rússia, Nizhny Novgorod

Mikhail Mironov

Privolzhsky Research Medical University of the Ministry of Healthcare of Russia

Email: mironovdoctor@gmail.com

6th year student of the Faculty of General Medicine

Rússia, Nizhny Novgorod

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2. Fig. 1. Structure of the causes of chronic kidney disease stage 5 in the studied patients on hemodialysis program

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3. Fig. 2. Frequency of prescription of individual antihypertensive drugs within different classes: A, class of beta-adrenoblockers; B, class of angiotensin II receptor antagonists; C, class of ACE inhibitors

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4. Fig. 3. Frequency of highly dialyzed drug molecules by class of antihypertensive drugs

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