PMID- 34144104 OWN - NLM STAT- MEDLINE DCOM- 20220117 LR - 20221102 IS - 1523-6838 (Electronic) IS - 0272-6386 (Print) IS - 0272-6386 (Linking) VI - 78 IP - 5 DP - 2021 Nov TI - Comparison of Dialysis Unit and Home Blood Pressures: An Observational Cohort Study. PG - 640-648 LID - S0272-6386(21)00665-X [pii] LID - 10.1053/j.ajkd.2021.04.013 [doi] AB - RATIONALE & OBJECTIVE: Prior studies of patients receiving maintenance hemodialysis have shown that, on average, blood pressure (BP) measured predialysis is higher than BP measured at home. We hypothesized that a subset of hemodialysis patients has BP that is higher when measured at home than when measured predialysis and this subgroup of patients has a higher prevalence of left ventricular hypertrophy. STUDY DESIGN: Prospective cohort. SETTING & PARTICIPANTS: 97 hypertensive hemodialysis patients enrolled in the Blood Pressure in Dialysis Study (BID), a randomized trial of comparing target predialysis BP /=6 times over 1 year. OUTCOME: Left ventricular mass index (LVMI) by cardiac magnetic resonance imaging. ANALYTICAL APPROACH: A hierarchical clustering analysis divided patients into 3 clusters based on the average and variability of differences in systolic predialysis and home BP. Clusters were compared with respect to clinical factors and LVMI. RESULTS: Mean differences between predialysis and home systolic BP were 19.1 (95% CI, 17.0 to 21.1) mm Hg for cluster 1 ("home lower"), 3.7 (95% CI, 1.6 to 5.8) mm Hg for cluster 2 ("home and predialysis similar"), and -9.7 (95% CI, -12.0 to -7.4) mm Hg for cluster 3 ("home higher"). Systolic BP declined during dialysis in clusters 1 and 2 but increased in cluster 3. Interdialytic weight gains did not differ. After adjusting for sex and treatment arm, LVMI was higher in cluster 3 than in clusters 1 and 2: differences in means of 10.6 +/- 4.96 (SE) g/m(2) (P = 0.04) and 12.0 +/- 5.08 g/m(2) (P = 0.02), respectively. LIMITATIONS: Limited statistical power. CONCLUSIONS: Nearly one-third of participants had home BPs higher than predialysis BPs. These patients had LVMI higher than those with similar or lower BPs at home, indicating that their BP may have been undertreated. CI - Copyright (c) 2021 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved. FAU - Miskulin, Dana C AU - Miskulin DC AD - Division of Nephrology, Tufts Medical Center, Boston, Massachusetts. Electronic address: dmiskulin@tuftsmedicalcenter.org. FAU - Jiang, Huan AU - Jiang H AD - Quality Management Department, Dialysis Clinic, Inc, Albuquerque, New Mexico. FAU - Gul, Ambreen AU - Gul A AD - Quality Management Department, Dialysis Clinic, Inc, Albuquerque, New Mexico. FAU - Pankratz, V Shane AU - Pankratz VS AD - Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. FAU - Paine, Susan S AU - Paine SS AD - Quality Management Department, Dialysis Clinic, Inc, Albuquerque, New Mexico. FAU - Gassman, Jennifer J AU - Gassman JJ AD - Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio. FAU - Jhamb, Manisha AU - Jhamb M AD - Renal-Electrolyte Division, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania. FAU - Kwong, Raymond Y AU - Kwong RY AD - Cardiovascular Division, Brigham and Women's Hospital, Boston, Massachusetts. FAU - Negrea, Lavinia AU - Negrea L AD - Division of Nephrology and Hypertension, Case Western Reserve University/University Hospitals Cleveland Medical Center, Cleveland, Ohio. FAU - Ploth, David W AU - Ploth DW AD - Division of Nephrology, Medical University of South Carolina, Charleston, South Carolina. FAU - Shaffi, Saeed Kamran AU - Shaffi SK AD - Department of Internal Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico. FAU - Harford, Antonia M AU - Harford AM AD - Quality Management Department, Dialysis Clinic, Inc, Albuquerque, New Mexico. FAU - Zager, Philip G AU - Zager PG AD - Quality Management Department, Dialysis Clinic, Inc, Albuquerque, New Mexico. LA - eng GR - R01 DK083424/DK/NIDDK NIH HHS/United States GR - UL1 TR002548/TR/NCATS NIH HHS/United States PT - Journal Article PT - Observational Study PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20210616 PL - United States TA - Am J Kidney Dis JT - American journal of kidney diseases : the official journal of the National Kidney Foundation JID - 8110075 SB - IM CIN - Am J Kidney Dis. 2021 Nov;78(5):621-623. PMID: 34340864 MH - Blood Pressure MH - Blood Pressure Monitoring, Ambulatory MH - Cohort Studies MH - Humans MH - *Hypertension/epidemiology MH - Hypertrophy, Left Ventricular/epidemiology MH - Prospective Studies MH - *Renal Dialysis PMC - PMC8631101 MID - NIHMS1753506 OTO - NOTNLM OT - Blood pressure (BP) OT - cardiovascular risk OT - end-stage renal disease (ESRD) OT - hemodialysis OT - home BP OT - left ventricular mass (LVM) OT - masked hypertension OT - measurement variability OT - predialysis BP EDAT- 2021/06/19 06:00 MHDA- 2022/01/18 06:00 PMCR- 2022/11/01 CRDT- 2021/06/18 20:13 PHST- 2020/10/05 00:00 [received] PHST- 2021/04/16 00:00 [accepted] PHST- 2021/06/19 06:00 [pubmed] PHST- 2022/01/18 06:00 [medline] PHST- 2021/06/18 20:13 [entrez] PHST- 2022/11/01 00:00 [pmc-release] AID - S0272-6386(21)00665-X [pii] AID - 10.1053/j.ajkd.2021.04.013 [doi] PST - ppublish SO - Am J Kidney Dis. 2021 Nov;78(5):640-648. doi: 10.1053/j.ajkd.2021.04.013. Epub 2021 Jun 16.