Published: 2019-07-24

Comparative study of ambulatory blood pressure monitoring in hemodialysis and non-dialysis CKD patients and their prognostic value

S. Senthil Kumar, S. Vithiavathi, T. Doraickannu


Background: Hypertension and chronic kidney disease are inextricably intertwined. Most patients with hypertension associated CKD die of heart attack and stroke before renal function. Ambulatory BP monitoring provides automated measurements of BP during a 24hrs period while patients engaged in their usual activities including sleep. Recommended normal value include an average daytime BP <135/85mmHg/night time BP <120/70mmHg and 24 hr BP <130/89mmHg. In patients with chronic kidney disease the control of hypertension slows the progression of end stage renal disease. This study was undertaken to define the prognostic role of ABPM in dialysis dependent and non-dialysis CKD patients so that better treatment strategies could be initiated to prevent adverse outcomes.

Methods: This prospective cross sectional study was conducted at Aarupadai Veedu Medical College and hospital, Puducherry in both dialysis dependent and non-dialysis CKD patients admitted in both ICU and medical wards. APBM was performed by using the properly validated ambulatory blood pressure monitor. The monitor records BP on the non-dominant arm every 20 minutes while awake and hourly while sleep for a total duration 24hrs in both hemodialysis dependent and non-hemodialysis patients. In  hemodialysis dependent patients ABPM was recorded on the second day of hemodialysis.

Results: The mean maximum systolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 146.23 and 166.12 mmHg respectively. The mean minimum systolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 122.11 and 122.45 mmHg respectively. The mean maximum diastolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 100.24 and 110.65mmHg respectively. The mean minimum diastolic blood pressure in dialysis dependent and non-dialysis CKD patients recorded was 78.65 and 80.67 mmHg respectively. In our study the prevalence of non-dipping in dialysis and non-dialysis CKD patients were 28% and 16% respectively.

Conclusions: Ambulatory blood pressure monitoring is considered the gold standard for the diagnosis of hypertension. Tight BP control is needed to limit the progression of renal disease and lessen cardiovascular morbidity and mortality. To achieve this goal ABPM should be widely adopted in patients with CKD.


Ambulatory blood pressure, Chronic kidney disease, Hemodialysis, Hypertension

Full Text:



Victor RG. In: systemic hypertension: Mechanism and diagnosis: Braunwald’s heart disease: A Textbook of Cardiovascular Medicine. 9th Ed. 2011:935-954.

Parati G, Stergiou GS, Asmar R, Bilo G, De Leeuw P, Imai Y, et al. European Society of Hypertension guidelines for blood pressure monitoring at home: a summary report of the Second International Consensus Conference on Home Blood Pressure Monitoring. J Hypert. 2008 Aug 1;26(8):1505-26.

Pickering TG, Miller NH, Ogedegbe G, Krakoff LR, Artinian NT, Goff D. Call to action on use and reimbursement for home blood pressure monitoring: a joint scientific statement from the American Heart Association, American Society of Hypertension, and Preventive Cardiovascular Nurses Association. Hypertension. 2008 Jul 1;52(1):10-29.

Dolan E, Stanton A, Thijs L, Hinedi K, Atkins N, McClory S, et al. Superiority of ambulatory over clinic blood pressure measurement in predicting mortality: the Dublin outcome study. Hypertension. 2005 Jul 1;46(1):156-61.

Drazner MH, Dries DL, Peshock RM, Cooper RS, Klassen C, Kazi F, et al. Left ventricular hypertrophy is more prevalent in blacks than whites in the general population: the Dallas Heart Study. Hypertension. 2005 Jul 1;46(1):124-9.

Stevens LA, Schmid CH, Greene T, Li L, Beck GJ, Joffe MM, et al. Factors other than glomerular filtration rate affect serum cystatin C levels. Kidney international. 2009 Mar 2;75(6):652-60.

Pogue V, Rahman M, Lipkowitz M, Toto R, Miller E, Faulkner M, et al. Disparate estimates of hypertension control from ambulatory and clinic blood pressure measurements in hypertensive kidney disease. Hypertension. 2009 Jan 1;53(1):20-7.

The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7). Hypertension. 2003;42:1206.

Glassock RJ, Pecoits-Filho R, Barberato SH. Left ventricular mass in chronic kidney disease and ESRD. Clinical Journal of the American Society of Nephrology. 2009 Dec 1;4(Supplement 1):S79-91.

Slinin Y, Guo H, Gilbertson DT, Mau LW, Ensrud K, Rector T, et al. Meeting KDOQI guideline goals at hemodialysis initiation and survival during the first year. Clin J Am Soci Nephrol. 2010 Sep 1;5(9):1574-81.

Levey AS. A simplified equation to predict glomerular filtration rate from serum creatinine. J Am Soc Nephrol. 2000;11:A0828.

Kidney disease improving global outcome (KDIGO) blood pressure work group. KDIGO clinical practice guideline for the management of blood pressure in chronic kidney disease. Kidney Int Suppls. 2012;2:337-414.

Anderson MJ, Khawndi W, Agarwal R. Home blood pressure monitoring in CKD. Am J Kidney Dis. 2005;45:994-1001.

Agarwal R. Hypertension and survival in chronic hemodialysis patients-past lessons and future opportunities. Kidney Int. 2005;67:1-13.

Coomer RW, Schulman G, Breyer JA, Shyr Y. Ambulatory blood pressure monitoring in dialysis patients and estimation of mean interdialytic blood pressure. Am J Kidney Dis. 1997 May 1;29(5):678-84.

Mitra S, Chandna SM, Farrington K. what is hypertension in chronic haemodialysis? The role in interdialytic blood pressure monitoring. Nephrol Dial Transplant. 1999;14:2915-2921.

Santos SF, Mendes RB, Santos CA, Dorigo D, Peixoto AJ. Profile of interdialytic blood pressure in hemodialysis patients. Am J Nephrol. 2003;23(2):96-105.

Portaluppi F, Vergnani L, Manfredini R, degli Uberti EC, Fersini C. Time-dependent effect of isradipine on the nocturnal hypertension in chronic renal failure. Am J Hypertension. 1995 Jul 1;8(7):719-26.

Baumgart P, Walger P, Gemen S, von Eiff M, Raidt H, Rahn KH. Blood pressure elevation during the night in chronic renal failure, hemodialysis and after renal transplantation. Nephron. 1991;57(3):293-8.

Van De Borne P, Tielemans C, Collart F, Vanherweghem JL, Degaute JP. Twenty-four-h blood pressure and heart rate patterns in chronic hemodialysis patients. Am J kidney Dis. 1993;22:419-25.

Narita I, Okada M, Omori S, Nagai M, Sawanaka N, Kondo D, et al. The circadian blood pressure rhythm in non-diabetic hemodialysis patients. Hypertens Res. 2001;24:111-7.

Mitra S, Chandana SM. What is hypertension in chronic hemodialysis? The role of interdialytic blood pressure monitoring. Nephrol Dial Transplant. 1999;9:167-72.

Chaudhuri A, Sutherland SM, Begin B, Salsbery K, McCabe L, Potter D, et al. Role of 24 hour Ambulatory Blood Pressure Monitoring in children on dialysis. Clin J Am Soc Nephrol. 2011;6(4):870-6.

Farmer CK, Goldsmith DJ, Cox J, Dallyn P, Kingswood JC, Sharpstone P. An investigation of the effect of advancing uraemia, renal transplantation on blood pressure diurnal variability. Nephrol Dial Transplant. 1997;12:2301-7.