Original article

Association between intradialytic blood pressure and left ventricular mass index in end-stage renal disease

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Abstract

Aim: To evaluate whether single and two-month average intradialytic blood pressure (BP) measurements, including systolic blood pressure (SBP) and diastolic blood pressure (DBP), are associated with left ventricular mass index (LVMI), and whether intradialytic BP thresholds discriminate left ventricular hypertrophy (LVH) in patients with end-stage renal disease on haemodialysis.

Methods: This prospective observational study was conducted at the Dialysis Centre in Doboj between June and September 2017 and included 97 adults on chronic haemodialysis for at least five months. Intradialytic BP was assessed as a single measurement and as a two-month average. LVMI and LVH were evaluated by echocardiography. Multivariable regression examined associations with LVMI after adjustment for age, haemoglobin, and volume overload, while receiver operating characteristic (ROC) curve analysis assessed LVH discrimination.

Results: Median dialysis duration was 3.9 years, and 24 patients (25%) had ischemic heart disease. Median LVMI was 117.5 g/m2, and LVH was present in 44 patients (45%). After adjustment for relevant covariates, single intradialytic SBP and DBP measurements were not associated with LVMI. In contrast, two-month average SBP (B = 0.5364, p = 0.0075) and DBP (B = 0.7308, p = 0.0299) remained independently associated with LVMI. Two-month average SBP showed moderate LVH discrimination (area under the curve (AUC) 0.711; p = 0.0001), with an exploratory cut-off of >143 mmHg.

Conclusion: Two-month average intradialytic SBP was independently associated with higher LVMI and showed moderate discrimination for LVH but requires external validation.

Keywords: echocardiography, hypertension, hypertrophy, left ventricular, renal dialysis