| 1st author Year of publication Reference | Aim of the study | Study design Method of BP measurement Follow-up period | Number Population (Country, KRT modality) | Primary analysis | Result/Conclusion |
|---|---|---|---|---|---|
| Agarwal, 2006 (13) | Determine the magnitude of the difference and the variability in the difference between BP that is recorded in the dialysis environment, before and after the dialysis procedure, and ABPM that is performed simultaneously in the haemodialysis population. | Meta-Analysis (1992-2003) ABPM – measured 24-48 hr duration some including dialysis session itself Dialysis unit BP – 7 studies used standard BP monitoring and rest ‘routine’ BP Some averaged over few weeks- months and some were single point measurements | 692 Countries of studies not reported HD | Differences between the dialysis unit BP, i.e., predialysis systolic (SBP) and diastolic (DBP), and postdialysis SBP and DBP and the corresponding ABPM BP (SBP or DBP) were calculated | Dialysis unit blood pressures have poor agreement with ABPM. Unable to calculate a pooled estimate using standard meta-analytic methods due to significant heterogeneity between studies. SD of the difference of the pooled observations between systolic ABP and predialysis SBP was 16.7 mmHg with limits of agreement of 41.7 mmHg to −25.2 mmHg. Predialysis diastolic BP overestimated the ABP with wide agreement limits (23.7 to -18.9 mmHg). Postdialysis BP underestimated average ABP with wide agreement limits for both postdialysis systolic BP (33.1 to -36.3 mmHg) and diastolic BP (19.3 to -23.9 mmHg). |
| Agarwal, 2006 (12) | To assess the relationship between BP recordings obtained in the dialysis unit by routine and standardized methods; home BP recordings obtained by the patients; and the reference standard of 44-h interdialytic ambulatory BP recordings. | Cohort study ABPM – 44 hr interdialytic BP Dialysis unit – Routine and standardised BP measurements averaged for 2 weeks Home BP – 3x daily for one week | 104 Indiana University, Indianapolis, US Predominantly black (75%) HD | Sensitivity and specificity of haemodialysis unit BP, Home BP in diagnosing hypertension compared with ambulatory blood pressure monitoring | Routine dialysis unit BP measurements have marginal performance in the diagnosis of hypertension Only home BP and post-dialysis standardised BP had an acceptable sensitivity and specificity. One week averaged systolic home BP of 150 mmHg or post-dialysis standardized BP of 122 mmHg has both high sensitivity and specificity to predict hypertension assessed by ambulatory BP monitoring |
| Agarwal, 2009 (16) | Evaluate the relationship of concurrent reduction in home BP, predialysis BP and postdialysis BP compared to the gold standard of interdialytic ambulatory BP measurements – Prespecified goal of DRIP Trial | RCT (DRIP) ABPM- 44 hr interdialytic BP Dialysis unit BP- Routine dialysis unit BP – mean of 3 dialysis sessions Home BP- 3 x daily for 1 week | 150 Indiana University, Indianapolis, US Predominantly black HD 8 weeks | Changes from baseline in home, predialysis BP and postdialysis BP were compared to interdialytic 44-hour ambulatory BP at 4 weeks and 8 weeks. | The changes in response to nonpharmacological intervention in haemodialysis patients with hypertension can be most reliably detected by 44-hour interdialytic ambulatory BP monitoring as early as after 4 weeks Predialysis SBP is not as sensitive as ambulatory BP in detecting this change but post dialysis BP can detect a change although may not persist over time in interdialytic period Home BP can reliably detect changes in BP at 8 weeks but may not detect changes at 4 weeks Ambulatory and home BP were more reproducible, i.e. they had greater test-re- test reliability compared to predialysis and postdialysis BP. |
| Agarwal, 2010 (4) | To compare mortality for haemodialysis patients with dialysis unit BP, ambulatory BP and Home BP monitoring to see if one offers more prognostic value than others | Cohort study ABPM – 44 hr interdialytic BP Dialysis unit – Routine and standardised BP measurements averaged for 2 weeks Home BP – 3x daily for one week | 326 Indiana University, Indianapolis, US Predominantly black (75%) HD Mean duration - 32 months | All-cause mortality for different blood pressure measurements | A significant relationship between increasing levels of systolic blood pressure and all cause mortality was seen with home and ambulatory blood pressure. Dialysis unit BP recordings were of no prognostic importance. Systolic ambulatory BP associated with least mortality was between 110–120 mmHg. The “best” systolic home BP was between 120–130 mmHg. |
| Agarwal, 2014 (18) | Discuss the diagnosis, epidemiology, and management of hypertension among dialysis patients | Review article | n/a | Home BP better than pre and post dialysis BP readings BP measurements to be made twice daily (on waking up in the morning and just before going to sleep) after a midweek dialysis for 4 days |
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| Alborzi, 2007 (11) | Evaluate the presence, strength, and shape of the relationship among BP that are measured using various modalities (home, ambulatory, and dialysis unit) and cardio- vascular and all-cause mortality in HD patients. | Prospective Cohort study | 150 Indiana University, Indianapolis, US Predominantly black (75%) HD 24 months | All cause mortality for ambulatory, Home BP, HD unit pre and post dialysis routine and standard BP | Measurements in the dialysis unit for SBP and DBP were not predictive of total mortality although postdialysis SBP was associated with an increase in cardiovascular mortality. Ambulatory BP was associated with a nearly 50% higher death rate for a 1-SD or 22.3/13.8-mmHg increment in SBP/DBP. In comparison, home BP was associated with a 35 to 40% elevation in risk for death. BP in different measurement groups divided in to four quartiles. BP measurements in 2nd quartile were associated with lowest mortality and BP in 4th quartile of ABPM (>140) was associated with significantly high mortality compared to first quartile. |
| Bansal, 2015 (22) | 1- Delineate the shapes and strengths of the association of SBP with mortality at eGFR <30 mL/min/1.73 m2 (but not on dialysis) and 2- to compare the association between dialysis-unit SBP versus out-of-dialysis-unit SBP with mortality among the participants who progressed to ESRD and initiated haemodialysis. | Cohort (CRIC) EGFR <30 – Standardised BP in CRIC study visit Dialysis unit BP- average of 4 sessions BP measured at the start of HD session Out-of-unit BP- standardised BP measured in CRIC study visit after initiation of HD | n=1705 n=403 n=326 Multi-Centre, US CKD 4 and 5 and HD | All cause mortality compared to SBP in CKD 5, Dialysis unit BP and out of office SBP in incident HD patients. | A U-shaped association between dialysis-unit SBP and mortality was observed among those who started haemodialysis. A linear association between out-of-dialysis-unit SBP and mortality (hazard ratio, 1.26 [95% confidence interval, 1.14-1.40] per every 10 mm Hg increase). |
| Bansal, 2021 (15) | Randomised to home BP vs predialysis BP to guide BP management (target <140 in each group) | Pilot RCT Home BP 2 readings every 2 weeks (mid week intradialytic day am and pm) Dialysis unit BP- Predialysis BP from over 2 weeks (average of 6 sessions) | 50 University of Washington and the University of California, San Francisco – US HD 4 months | Feasibility, adherence, safety and tolerability of home BP measurement | Demonstrated feasibility and high adherence to home BP measurement and treatment in haemodialysis patients and there were no safety concerns. Home SBP was on average 4.6mmHg lower than dialysis unit BP at baseline. Secondary outcomes Pre-dialysis SBP was similar in the two arms at baseline, and started to separate by week 6 with SBP becoming lower among those randomized to pre-dialysis BP treatment arm, which was sustained through the last several weeks of the intervention – Dry weight adjustment was the most common intervention. No significant discordance between home BP and 44-hour ABPM at baseline in terms of classifying blood pressure as being above or below 140 mmHg |
| Cohen, 2014 (19) | Review | n/a | Home BP readings more closely associated with ABPM Home BP readings more reproducible from one week to next BP measured 2x /day for 4 days following midweek dialysis session |
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| Da Silva, 2009 (17) | Whether antihypertensive treatment using home BP or predialysis BP can improve BP control in HD patients | RCT Home BP – 2 x day measurements for 7 days Predialysis BP- average of 9 consecutive HD sessions routine pre dialysis BP ABPM- 24 hr monitoring after midweek HD session | 97 Single Centre, Brazil HD 6 months | BP control pre and post intervention using ABPM between intervention groups And changes in LV mass between groups | Patients HBPM (home BP monitoring) had better BP control after 6 months No change in LV mass between groups Patients in intervention group (HBPM) had their BP medications adjusted monthly using HBPM readings. Patients in the intervention group has significant reduction in their BP control pre and post intervention as measured by ABPM (BP 144 ± 14 mmHg and 135 ± 12 mmHg P<0.05 respectively). Additionally, a significant number of patients also developed a dipping BP pattern during sleep after 6 months (11.7% versus 38.2%, P < 0.05). There was also a significant reduction in predialysis SBP between the beginning and end of the study (157 ± 25 mmHg versus 147 ± 18 mmHg; P < 0.05) in HBPM group. Echocardiographic measures – no significant difference in any of the parameters between both groups |
| Fagugli, 2009 (10) | Examine the differences between prediaysis BP, inter-HD (iHD) or HD day 24 h ABPM, with 48 h ABPM, to predict BP burden and hypertension. | Cohort study ABPM – 48 hour BP including a midweek dialysis day and off day Prediaylysis BP- routine measurements measured at each dialysis unit- Mean readings from 1 month | 163 Regional Hospital of Perugia, Italy HD | Difference between 48 hour ABPM and predialysis BP, iHD or HD day 24 hour ABPM | Predialysis BP overestimated BP values in relation to 48 h ABPM, both in the case of SBP and DBP (systolic 48 h ABPM = 139.6 1 20.2 mmHg and predialysis SBP = 142.8 1 17.2 mmHg, P < 0.01; diastolic 48 h ABPM = 76.6 1 10.8 mmHg and predialysis DBP = 79.5 1 9.1 mmHg, P < 0.01) Systolic and diastolic ABPM of 24 h recorded during iHD day were significantly higher than those recorded during HD day (SBP: 141.2 1 20.8 vs 137.9 1 20.9 mmHg, P < 0.01; DBP: 77.1 1 11.1 vs 76.1 1 10.9 mmHg, P < 0.01). ABPM of 24 h, iHD or HD day, was not different from 48 h ABPM Prevalence of BP levels in the range of hypertension was reported to be 80.5% when BP measurements were performed using 48 h ABPM, without any difference if ABPM was performed on off-dialysis day (81.2%) or on HD day (73.4%). The prevalence of BP levels in the range of hypertension was significantly lower if predialysis BP was used. (61.7%, c2 = 13.28; P < 0.001) |
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