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Defining Cut-off of Intradialytic Hypertension in Indonesian Population

Background: Increasing BP during maintenance hemodialysis or intradialytic hypertension (IDH) is associated with increased morbidity and mortality. Some studies have tried to define IDH, but there is limited study published reporting the definition of IDH in Indonesian population. Objective: To define the criteria of IDH in Indonesian population. Method: We performed a cross-sectional study in adult hemodialysis (HD) patients in our hospital. We recorded those variables for 2 consecutive weeks (6 HD sessions): pre-, intra-, and post-HD systolic blood pressure (SBP). Average SBP of pre-HD (method 1), ID (method 2), post-HD (method 3), pre-post-HD (method 4), and pre-intra-post-HD (method 5) were tested using ROC curved to gain the best sensitivity and specificity. Result: Among the 46 participants, mean age was 52 ± 11.7 years, 58.7% were men, average length of HD was 2.3 ± 1.6 year, body mass index was 21.5 ± 3 kg/m2, with body weight pre-HD 56.9 ± 9.3 kg, and post-HD 54.5 ± 9.1 kg, serum albumin 3.3 ± 0.4 g/dL and serum hemoglobin 10.6 ± 1.2 g/dL. The most common etiology of chronic kidney disease was hypertension in 50% subject. Eighty nine percent of which were on antihypertensive drugs, average number of antihypertensive used was 1.4 ± 1.1. From ROC curve of at least 4 of 6 HD sessions, the highest sensitivity and specificity gained by post-HD SBP (method 3) with 94% sensitivity and 82% specificity, with cut-off points SBP of 148 mmHg. Conclusion: Consideration using post-HD SBP as preferable method in diagnosing IDH in Indonesian population should be done with cut-off point SBP of 148 mmHg.