Intradialytic hypertension (IHT), defined by an increase of 10mmHg [1Eftimovska-Otovic N., et al. Clinical Characteristics of Patients with Intradialytic Hypertension Pril(Makedon Akad Nauk Umet Odd Med Nauki) 2015 ;  36 (2) : 187-193 [cross-ref]

Cliquez ici pour aller à la section Références], is a frequent but poorly understood complication of hemodialysis treatment [2Van Buren P. The prevalence of persistent intradialytic hypertension in a hemodialysis population with extended follow-up Int J Artif Org 2012 ;

Cliquez ici pour aller à la section Références, 3Gunal A.I. Paradoxical rise in blood pressure during ultrafiltration is caused by increased cardiac output J Nephrol 2002 ;

Cliquez ici pour aller à la section Références], associated with an over-risk of mortality [4Inrig Jk. Association of blood pressure increases during hemodialysis with 2-year mortality in incident hemodialysis patients: a secondary analysis of the Dialysis Morbidity and Mortality Wave 2 Study AJKD 2009 ;

Cliquez ici pour aller à la section Références]. In spite of the association with clinical signs of extracellular volume expansion, in clinical practice the attempt of a dry weight was not always associated with a normalization of blood pressure. The aim of our study was to investigate the clinical and biological characteristics of patients with persistent intradialytic hypertension after the drop of their dry weight (DW).

From January 2013 to June 2013, 50 patients with IHT were identified based on the definition. According to the effect of dry weight reduction after 6 months, 2 groups of patients were described with and without effect on IHT. Demographics, clinical and biological data were analyzed. We estimated vascular status using a score. We also investigated differences in 5-year mortality and comorbidity.

The two groups were respectively constituted by 23 and 27 patients without significant differences for gender (OR [0.23; 2.94] P=0.78) or age (P=0.13). The patient's vascular status was not more high in the group 1 than in the group 2 (1.5 vs. 1.9; P=0.26). The reduction in dry weight was the same in two groups (−2,44 vs.−2.57; P=0.94), and no differences were found in the level of parathyroid hormone(169 vs. 387; P=0.9). The number of hypertension treatments was lower in the group 2 (1.7 vs. 2,5; P=0.05). The two group showed a similar 5year mortality (70 and 78% respectively, P=0.75).

Despite overhydratation correction, we could not explain intradialytic hypertension by vascular status alone. After improvement of IHT, mortality rate remains high.