Factors Contributing to Intradialytic Hypertension in Hemodialysis Patients

Yunie Armiyati(1*), Suharyo Hadisaputro(2), Shofa Chasani(3), Untung Sujianto(4)


(1) [Scopus-ID: 57221527723], Universitas Muhammadiyah Semarang
(2) Postgraduate Program of Health Polytechnic of Semarang.
(3) Faculty of Medicine, Universitas Muhammadiyah Semarang.
(4) Department of Nursing, Faculty of Medicine, Universitas Diponegoro.
(*) Corresponding Author

Abstract


Intradialytic hypertension (IDH) is the most common complication of hemodialysis patients in Indonesia. It must be controlled, to maintain the patient's quality of life and prevent worsening conditions. Some factors affecting IDH include predialysis fluid overload characterized by excessive interdialytic weight gain (IDWG), low adherence to fluid restriction and increased ultrafiltration during haemodialysis. The study aims to identify contributing factors of IDH. A case-control design was used in this study. A purposive sampling technique was used to recruit 92 samples at two centres of dialysis in Semarang, which was divided into case group (n=46) and control group (n=46). Data were analyzed using the Chi-square test by calculating Odds Ratios (OR). The finding showed that excessive IDWG (p=0,000, OR=16.95, 95% CI:5,56-51,65), low fluid adherence (p=0,001, OR=4,41, 95% CI:1,82-10,68) and excessive ultrafiltration (p=0,000, OR = 29,52, 95% CI:9,23-94,46) showed significant result. However, the incidence of IDH was not correlated with sex, age and length of haemodialysis. A greater increase in interdialytic weight requires lower fluid and higher ultrafiltration factors must be controlled precisely because those are considered as the risk factors for the high incidence of IDH. Excessive ultrafiltration is the most dominant risk factor in the high incidence of IDH.

Keywords


IDWG; fluid adherence; ultrafiltration; intradialytic hypertension; hemodialysis

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References


Pernefri. 10th Report of Indonesian Renal Registry 2017. Pernefri, editor. Jakarta: Perhimpunan Nefrologi Indonesia (PERNEFRI).; 2017.

Hinkle JL, Cheever KH. Brunner and Suddarth’s textbook of medical surgical nursing. 14th ed. Squazzo K, editor. Vol. 1. Philadelphia: Wolters Kluwer; 2018. p. 6112.

Pernefri. 11th Report Of Indonesian Renal Registry. 2018. Jakarta: Indonesia Renal Registry; 2018. p. 46.

Kallenbach JZ. Review of Hemodialysis for Nurses and Dialysis Personnel-E-Book. 10th ed. Mosby Company; 2020.

Van Buren PN. Pathophysiology and implications of intradialytic hypertension. Curr Opin Nephrol Hypertens. 2017/04/12. 2017;26:303–10.

Armiyati Y. Hipotensi dan hipertensi intradialisis pada Pasien Chronic Kidney Disease (CKD) saat menjalani hemodialisis di RS PKU Muhammadiyah Yogyakarta. In: Prosiding Seminar Nasional Unimus. Semarang; 2012. p. 126–35.

Georgianos PI, Agarwal R. Meet the Twins: Intradialytic and Interdialytic Hypertension. Am J Nephrol. 2018/10/23. 2018;48:292–4.

Van Buren PN, Toto R, Inrig JK. Interdialytic ambulatory blood pressure in patients with intradialytic hypertension. Curr Opin Nephrol Hypertens. 2011/11/30. 2012;21:15–23.

Choi C-Y, Park JS, Yoon KT, Gil HW, Lee EY, Hong SY %J P one. Intra-dialytic hypertension is associated with high mortality in hemodialysis patients. 2017;12:e0181060.

Nayak R, Attur RP, Arya M. Intradialytic Hypertension in Patients Unergoing Hemodialysis in Tertiary Care Hospital. Indian J Public Heal Res Dev. 2020;11:78.

Perdhana L, Chasani S. Intradialytic hypertension and six month–all cause mortality in hemodialysis patients. J Hypertens. 2021;39:e11.

Pebriantari KG, Dewi IGAPA. Hubungan komplikasi intra hemodialisis dengan kualitas hidup pada pasien Chronic Kidney Disease (CKD) stage V yang menjalani hemodialisis di Ruang Hemodialisa BRSU Tabanan Tahun 2017. J Ris Kesehat Nas. 2018;2:9–17.

Kale G, Mali M, Bhangale A, Somani J, Jeloka T. Intradialytic Hypertension Increases Non-access Related Hospitalization and Mortality in Maintenance Hemodialysis Patients. Indian J Nephrol. 2020/04/10. 2020;30:85–90.

Cheng Y, Li Y, Zhang F, Zhu J, Wang T, Wei M, et al. Interdialytic blood pressure variability and the risk of stroke in maintenance hemodialysis patients. 2020;99.

Choi C-Y, Park JS, Yoon KT, Gil HW, Lee EY, Hong SY. Intra-dialytic hypertension is associated with high mortality in hemodialysis patients. PLoS One. 2017;12:e0181060.

Chazot C. Use of a restricted-salt diet. Semin Dial. 2009;22:482–6.

Kandarini Y. Peran ultrafiltrasi terhadap hipertensi intradialitik dan hubungannya perubahan kadar: endothelin-1, asymmetric dimethylarginin dan nitric oxide. Universitas Airlangg; 2012.

Agarwal R, Light RP. Intradialytic hypertension is a marker of volume excess. Nephrol Dial Transpl. 2010/04/20. 2010;25:3355–61.

Chazot C, Jean G. Intradialytic hypertension: it is time to act. Nephron Clin Pr. 2010/04/24. 2010;115:c182-8.

Suwitra K. Penyakit Ginjal Kronik. In: Sudoyo AW, Setiyohadi B, Alwi I, K MSi, Setiati S, editors. Buku Ajar Ilmu Penyakit Dalam. 6th ed. Jakarta: FK-UI; 2014. p. 570–3.

Istanti YP. Faktor-faktor yang berkontribusi terhadap interdialytic weight gains pada pasien Chronic Kidney Diseases yang menjalani hemodialisis. Mutiara Med J Kedokt dan Kesehat. 2016;11:118–30.

Priska NP, Herlina S. Efikasi diri pembatasan cairan terhadap intradialytic weight gain pasien Gagal Ginjal Kronik di Ruang Hemodialisa RSUD Pasar Minggu. J Ilm Ilmu Keperawatan Indones. 2019;9:601–8.

NKF. Update of the KDOQI clinical practice guideline for hemodialysis adequacy. Minessota: National Kidney Foundation; 2015.

Ren H, Gong D, He X, Jia F, He Q, Xu B, et al. Evaluation of Intradialytic Hypertension Using Bioelectrical Impedance Combined With Echocardiography in Maintenance Hemodialysis Patients. Ther Apher Dial. 2017/12/08. 2018;22:22–30.

Gathmyr D, Nugroho P, Awang I, Lydia A, Bawazier LA, Khumaedi I, et al. Contributing factors of intradialytic hypertension in maintenance haemodialysis patients. J Hypertens. 2021;39:e409.

Lolyta R, Solechan A. Analisis faktor yang mempengaruhi tekanan darah hemodialisis pada klien Gagal Ginjal Kronik (studi kasus di RS Telogorejo Semarang). J Ilmu Keperawatan dan Kebidanan. 2012;1:58–70.

Oshvandi K, Fathabadi MA, Falahi Nia GH, Mahjub H, Adib-Hajbaghery M. Effects of Small Group Education on Interdialytic Weight Gain, and Blood Pressures in Hemodialysis Patients. Nurs Midwifery Stud. 2013;1:128–32.

Inrig JK, Oddone EZ, Hasselblad V, Gillespie B, Patel UD, Reddan D, et al. Association of intradialytic blood pressure changes with hospitalization and mortality rates in prevalent ESRD patients. Kidney Int. 2007;71:454–61.

Van Buren PN, Inrig JK. Mechanisms and treatment of intradialytic hypertension. Blood Purif. 2016;41:188–93.

Sebastian S, Filmalter C, Harvey J, Chothia MY. Intradialytic hypertension during chronic haemodialysis and subclinical fluid overload assessed by bioimpedance spectroscopy. Clin Kidney J. 2016/08/02. 2016;9:636–43.

Zou LX, Sun L. Forecast post-dialysis blood pressure in hemodialysis patients with intradialytic hypertension. Clin Exp Hypertens. 2018/10/17. 2019;41:571–6.

Pace RC. Fluid management in patients on hemodialysis. Nephrol Nurs J. 2007;34:557.

Locatelli F, Cavalli A, Tucci B. The growing problem of intradialytic hypertension. Nat Rev Nephrol. 2009/11/26. 2010;6:41–8.

Widiyanto P, Hadi H, Wibowo T. Korelasi positif perubahan berat badan interdialisis dengan perubahan tekanan darah pasien post hemodialisa. J Ners dan Kebidanan Indones. 2014;2:1–8.

Suparti S, Febrianti H. Is there anycorrelation between intradialytic complications and interdialytic weight gain (IDWG)? Ann Trop Med Public Heal. 2019;22:145–9.

Zhang Y, Zhang X, Li J, Liu X, Cui C, Yuan A, et al. Dry-weight reduction improves intradialytic hypertension only in patients with high predialytic blood pressure. Blood Press Monit. 2019/02/27. 2019;24:185–90.

Andriyani DA, Armiyati Y. Karakteristik pasien terhadap IDWG pada pasien Penyakit Ginjal Kronis yang menjalani Hemodialisis di RSUD Kota Semarang. Semarang: Unimus; 2013.

Johan A. Hubungan Besar Ultrafiltrasi saat Hemodialisis dengan Kejadian Peningkatan Tekanan Darah Intradialitik pada Pasien Gagal Ginjal Kronik. 2016;

Armiyati Y, Hadisaputro S, Chasani S, Sujianto U. High Ultrafiltration Increasing Intradialytic Blood Pressure on Hemodialysis Patients. South East Asia Nurs Res. 2021;3:8–15.


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DOI: https://doi.org/10.26714/seanr.3.2.2021.73-80

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