Relationship Between Interdialytic Weight Gain and Blood Pressure Among Prevalent Hemodialysis Patients

Jula K. Inrig, Uptal D. Patel, Barbara S. Gillespie, Vic Hasselblad, Jonathan Himmelfarb, Donal Reddan, Robert M. Lindsay, James F. Winchester, John Stivelman, Robert Toto, Lynda A. Szczech

Research output: Contribution to journalArticle

73 Citations (Scopus)

Abstract

Background: Hypertension is common in hemodialysis patients; however, the relationship between interdialytic weight gain (IDWG) and blood pressure (BP) is incompletely characterized. This study seeks to define the relationship between IDWG and BP in prevalent hemodialysis subjects. Study Design, Setting, & Participants: This study used data from 32,295 dialysis sessions in 442 subjects followed up for 6 months in the Crit-Line Intradialytic Monitoring Benefit (CLIMB) Study. Outcomes & Measurements: Mixed linear regression was used to analyze the relationship between percentage of IDWG (IDWG [%] = [current predialysis weight - previous postdialysis weight]/dry weight * 100) as the independent variable and systolic BP (SBP) and predialysis - postdialysis SBP (ΔSBP) as dependent variables. Results: In unadjusted analyses, every 1% increase in percentage of IDWG was associated with a 1.00 mm Hg (95% confidence interval [CI], ±0.24) increase in predialysis SBP (P < 0.0001), 0.65 mm Hg (95% CI, ±0.24) decrease in postdialysis SBP (P < 0.0001), and 1.66 mm Hg (95% CI, ±0.25) increase in ΔSBP (P < 0.0001). After controlling for other significant predictors of SBP, every 1% increase in percentage of IDWG was associated with a 1.00 mm Hg (95% CI, ±0.24) increase in predialysis SBP (P < 0.0001) and a 1.08 mm Hg (95% CI, ±0.22) increase in ΔSBP with hemodialysis (P < 0.0001). However, in subjects with diabetes as the cause of end-stage renal disease, subjects with lower creatinine levels, and older subjects, the magnitude of the association between percentage of IDWG and predialysis SBP was less pronounced. The magnitude of percentage of IDWG on ΔSBP was less pronounced in younger subjects and subjects with lower dry weights. Results were similar with diastolic BP. Limitations: Hemodialysis BP measurements are imprecise estimates of BP and true hemodynamic burden in dialysis subjects. Conclusions: In prevalent hemodialysis subjects, increasing percentage of IDWG is associated with increases in predialysis BP and BP changes with hemodialysis; however, the magnitude of the relationship is modest and modified by other clinical factors. Thus, although overall volume status may impact on BP to a greater extent, day-to-day variations in weight gain have a modest role in BP increases in prevalent subjects with end-stage renal disease.

Original languageEnglish (US)
JournalAmerican Journal of Kidney Diseases
Volume50
Issue number1
DOIs
StatePublished - Jul 2007

Fingerprint

Weight Gain
Renal Dialysis
Blood Pressure
Confidence Intervals
Weights and Measures
Chronic Kidney Failure
Dialysis
Linear Models
Creatinine
Hemodynamics
Hypertension

Keywords

  • blood pressure
  • hemodialysis
  • Interdialytic weight gain

ASJC Scopus subject areas

  • Nephrology

Cite this

Inrig, J. K., Patel, U. D., Gillespie, B. S., Hasselblad, V., Himmelfarb, J., Reddan, D., ... Szczech, L. A. (2007). Relationship Between Interdialytic Weight Gain and Blood Pressure Among Prevalent Hemodialysis Patients. American Journal of Kidney Diseases, 50(1). https://doi.org/10.1053/j.ajkd.2007.04.020

Relationship Between Interdialytic Weight Gain and Blood Pressure Among Prevalent Hemodialysis Patients. / Inrig, Jula K.; Patel, Uptal D.; Gillespie, Barbara S.; Hasselblad, Vic; Himmelfarb, Jonathan; Reddan, Donal; Lindsay, Robert M.; Winchester, James F.; Stivelman, John; Toto, Robert; Szczech, Lynda A.

In: American Journal of Kidney Diseases, Vol. 50, No. 1, 07.2007.

Research output: Contribution to journalArticle

Inrig, JK, Patel, UD, Gillespie, BS, Hasselblad, V, Himmelfarb, J, Reddan, D, Lindsay, RM, Winchester, JF, Stivelman, J, Toto, R & Szczech, LA 2007, 'Relationship Between Interdialytic Weight Gain and Blood Pressure Among Prevalent Hemodialysis Patients', American Journal of Kidney Diseases, vol. 50, no. 1. https://doi.org/10.1053/j.ajkd.2007.04.020
Inrig, Jula K. ; Patel, Uptal D. ; Gillespie, Barbara S. ; Hasselblad, Vic ; Himmelfarb, Jonathan ; Reddan, Donal ; Lindsay, Robert M. ; Winchester, James F. ; Stivelman, John ; Toto, Robert ; Szczech, Lynda A. / Relationship Between Interdialytic Weight Gain and Blood Pressure Among Prevalent Hemodialysis Patients. In: American Journal of Kidney Diseases. 2007 ; Vol. 50, No. 1.
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T1 - Relationship Between Interdialytic Weight Gain and Blood Pressure Among Prevalent Hemodialysis Patients

AU - Inrig, Jula K.

AU - Patel, Uptal D.

AU - Gillespie, Barbara S.

AU - Hasselblad, Vic

AU - Himmelfarb, Jonathan

AU - Reddan, Donal

AU - Lindsay, Robert M.

AU - Winchester, James F.

AU - Stivelman, John

AU - Toto, Robert

AU - Szczech, Lynda A.

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N2 - Background: Hypertension is common in hemodialysis patients; however, the relationship between interdialytic weight gain (IDWG) and blood pressure (BP) is incompletely characterized. This study seeks to define the relationship between IDWG and BP in prevalent hemodialysis subjects. Study Design, Setting, & Participants: This study used data from 32,295 dialysis sessions in 442 subjects followed up for 6 months in the Crit-Line Intradialytic Monitoring Benefit (CLIMB) Study. Outcomes & Measurements: Mixed linear regression was used to analyze the relationship between percentage of IDWG (IDWG [%] = [current predialysis weight - previous postdialysis weight]/dry weight * 100) as the independent variable and systolic BP (SBP) and predialysis - postdialysis SBP (ΔSBP) as dependent variables. Results: In unadjusted analyses, every 1% increase in percentage of IDWG was associated with a 1.00 mm Hg (95% confidence interval [CI], ±0.24) increase in predialysis SBP (P < 0.0001), 0.65 mm Hg (95% CI, ±0.24) decrease in postdialysis SBP (P < 0.0001), and 1.66 mm Hg (95% CI, ±0.25) increase in ΔSBP (P < 0.0001). After controlling for other significant predictors of SBP, every 1% increase in percentage of IDWG was associated with a 1.00 mm Hg (95% CI, ±0.24) increase in predialysis SBP (P < 0.0001) and a 1.08 mm Hg (95% CI, ±0.22) increase in ΔSBP with hemodialysis (P < 0.0001). However, in subjects with diabetes as the cause of end-stage renal disease, subjects with lower creatinine levels, and older subjects, the magnitude of the association between percentage of IDWG and predialysis SBP was less pronounced. The magnitude of percentage of IDWG on ΔSBP was less pronounced in younger subjects and subjects with lower dry weights. Results were similar with diastolic BP. Limitations: Hemodialysis BP measurements are imprecise estimates of BP and true hemodynamic burden in dialysis subjects. Conclusions: In prevalent hemodialysis subjects, increasing percentage of IDWG is associated with increases in predialysis BP and BP changes with hemodialysis; however, the magnitude of the relationship is modest and modified by other clinical factors. Thus, although overall volume status may impact on BP to a greater extent, day-to-day variations in weight gain have a modest role in BP increases in prevalent subjects with end-stage renal disease.

AB - Background: Hypertension is common in hemodialysis patients; however, the relationship between interdialytic weight gain (IDWG) and blood pressure (BP) is incompletely characterized. This study seeks to define the relationship between IDWG and BP in prevalent hemodialysis subjects. Study Design, Setting, & Participants: This study used data from 32,295 dialysis sessions in 442 subjects followed up for 6 months in the Crit-Line Intradialytic Monitoring Benefit (CLIMB) Study. Outcomes & Measurements: Mixed linear regression was used to analyze the relationship between percentage of IDWG (IDWG [%] = [current predialysis weight - previous postdialysis weight]/dry weight * 100) as the independent variable and systolic BP (SBP) and predialysis - postdialysis SBP (ΔSBP) as dependent variables. Results: In unadjusted analyses, every 1% increase in percentage of IDWG was associated with a 1.00 mm Hg (95% confidence interval [CI], ±0.24) increase in predialysis SBP (P < 0.0001), 0.65 mm Hg (95% CI, ±0.24) decrease in postdialysis SBP (P < 0.0001), and 1.66 mm Hg (95% CI, ±0.25) increase in ΔSBP (P < 0.0001). After controlling for other significant predictors of SBP, every 1% increase in percentage of IDWG was associated with a 1.00 mm Hg (95% CI, ±0.24) increase in predialysis SBP (P < 0.0001) and a 1.08 mm Hg (95% CI, ±0.22) increase in ΔSBP with hemodialysis (P < 0.0001). However, in subjects with diabetes as the cause of end-stage renal disease, subjects with lower creatinine levels, and older subjects, the magnitude of the association between percentage of IDWG and predialysis SBP was less pronounced. The magnitude of percentage of IDWG on ΔSBP was less pronounced in younger subjects and subjects with lower dry weights. Results were similar with diastolic BP. Limitations: Hemodialysis BP measurements are imprecise estimates of BP and true hemodynamic burden in dialysis subjects. Conclusions: In prevalent hemodialysis subjects, increasing percentage of IDWG is associated with increases in predialysis BP and BP changes with hemodialysis; however, the magnitude of the relationship is modest and modified by other clinical factors. Thus, although overall volume status may impact on BP to a greater extent, day-to-day variations in weight gain have a modest role in BP increases in prevalent subjects with end-stage renal disease.

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KW - hemodialysis

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