Inpatient Management of Blood Pressure and Fluid Overload in Patients With End-Stage Renal Disease on Hemodialysis

Abstract

Specific Aims: The main objectives of the study are to compare the number of antihypertensive medications upon admission versus discharge, determine the fluctuation index ((SBPmax – SBPmin)/Avg)x100) between inpatient HD sessions, determine the minimum SBP during each inpatient HD session and compare pre-HD weight to post-HD weight for each inpatient HD session to determine inter-dialytic weight gain. The findings of this study are expected to have a positive impact on the management of blood pressure and fluid overload in HD patients by identifying the adverse effects associated with an increased anti-hypertensive medication burden. Methods: The Institutional Review Board approved this retrospective chart review. The electronic medical record system identified patients that received HD between January 1, 2010 and January 1, 2013. The following data was collected: the admission diagnosis and patient comorbidities; time on dialysis prior to admission and time since last HD session; the number and class of anti-hypertensive medications documented on admission, while inpatient, and upon discharge; the use of midodrine, receipt of erythropoietin stimulating agents, total time on dialysis while admitted, intra-dialytic hypotensive events, blood pressure readings pre- and post-HD, and inter-dialytic weight gain. Descriptive and demographic variables were also collected from the electronic medical record systems. The investigators will use this information to compare the number of anti-hypertensive medications upon admission versus discharge, determine the fluctuation of systolic blood pressure (SBP) between each inpatient HD session, determine the minimum SBP during each inpatient HD session and compare pre-HD weight to post-HD weight to determine inter-dialytic weight gain and total volume removed per each HD session. Descriptive statistics will be used to analyze our demographic data. Multiple linear regression analyses will be completed to evaluate independent predictors of inter-dialytic weight gain and intra-dialytic hypotension. Main Results: Pending Conclusion: Pending