| 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 | Results/Conclusion |
|---|---|---|---|---|---|
| Argilés 2004 (41) | To assess the participation of interdialytic body weight gain variations in the seasonal profile of blood pressure | Prospective observational trial Routine systolic and diastolic blood pressure while in a supine position on dialysis Observation for 7 years and 6 months; mean follow up time 42.6 ± 3.4 months | 99 stable satellite HD patients France HD | The effect of interdialytic body weight gain variations in the seasonal profile of blood pressure | Blood pressure varied throughout the year, following a cyclic pattern. Systolic and diastolic blood pressures were strongly correlated with interdialytic body weight gain (r= 0.925; P < 0.0001 and r= 0.888; P= 0.0001, respectively) |
| Bernier-Jean, 2022 (64) | To assess the benefits and safety of regular structured exercise training in adults undergoing dialysis on patient-important outcomes. To define the optimal prescription of exercise in adults undergoing dialysis. | Cochrane review. 21 studies included which reported on BP. Included studies of intra and interdialytic exercise No details on method of BP measurement. Follow-up 8 weeks to 2 years for all studies, follow up for just the studies looking at BP is not stated. | 21 studies, 324 participants. Authors from Australia, studies included from a variety of countries. HD | A subset of studies analysed the effect of aerobic and combined (aerobic and resistance) exercise on SBP and DBP | SBP: It is uncertain whether aerobic exercise reduced SBP due to low certainty of the evidence MD -3.99mm Hg, 95% CI -9.78 to 1.80; I2 = 45%; very low certainty evidence. There is very uncertain evidence that combined exercise effect SBP MD -8.69 mm Hg, 95% CI -13.69 to -3.69; I2 = 57%; very low certainty evidence) Note the heterogeneity was resolved after one study was excluded DBP: The authors conclude It is uncertain whether aerobic exercised reduces DBP, the pooled results show a mean increase in DBP with exercise MD 0.72 mm Hg, 95% CI -2.24 to 3.69; I2 = 31%, very low certainty evidence. Evidence is very uncertain whether combined exercise reduces DBP MD -4.45 mm Hg, 95% CI -5.98 to -2.91; I2 = 0%; very low certainty evidence. The quality of the evidence was very low due to the high risk of bias, the short duration of the interventions and follow-up and low number of participants. |
| Barati Boldaji, 2020 (59) | The effect of pomegranate juice on cardiometabolic risk factors, biomarkers of oxidative stress and inflammation in hemodialysis patients | Randomized cross over trial. Blood pressure was measured in pre-dialysis state twice with an interval of at least 5 min using a digital barometer (Microlife BP A200 AFIB). The mean of two measurements was used. Follow up: 8 weeks | 41 HD patients. 100mls pomegranate juice after HD x 3 per week for 8 weeks. 4 week wash out and then 8 weeks no juice. Country: Iran HD patients | The effect of pomegranate juice on total antioxidant capacity and malondialdehyde were the primary outcomes with interleukin-6 as the secondary outcome. Blood pressure along with serum lipid levels were also reported | Decrease in SBP MD -6.97 (-4.88 to -9.05) P<001 and DBP MD-6.88 (-9.08 to -4.68) p <00.1 overall mean BP changes: 137/97 to 128/90 |
| Chazot, 1995 (49) | To determine if long HD sessions have an effect on inter dialytic BP | Observational study Inter-dialytic ABPM Single session | 91 France Stable HD patients receiving 3x8hrd per week HD as standard | Linear regression to determine if there was a correlation between HD hours and inter-dialytic ABPM | The Mean BP was inversely correlated with the treatment duration, but not with inter-dialysis weight gain. |
| Cole NI, 2019 (52) | To determine the effect of dietary salt reduction on blood pressure in individuals receiving dialysis | Systematic review and meta-analysis of randomised controlled trials (RCTs) | Four RCTs (91 participants) met inclusion criteria UK HD patients | Primary outcome was change in systolic and diastolic blood pressure | Dietary salt reduction was associated with an 8.4 mmHg reduction in systolic blood pressure (95% CI 4.8-12.0, Ι2 = 0%), and a 4.4 mmHg reduction in diastolic blood pressure (95% CI 2.2-6.6, Ι2 = 0%). |
| Daud, 2021 (66) | Does counselling by home pharmacy care improve medication adherence and blood pressure | Controlled trial, participants randomized based on HD schedule. Average of 2 BP measurements in the morning and average of 2 BP measurements in the afternoon taken at home for 7 days in week 1 and 6 Follow- up 6 weeks | 58 hypertensive HD patients in Indonesia | Intervention group were counselled by pharmacist once a week at home, weeks 2-5 of trial. BP measured daily for first 7 days and then compared with BP measured in weeks 2 and 6. | Results reported as % of patients with a reduction in SBP and DBP in the control and intervention groups. Treatment group: 86% experienced reduction in SBP and 69% in DBP. Compared with control 17% reduction in SBP and 10% in DBP. Magnitude of reduction was not reported or mean reduction. Young population aged 39-59, 57% high school graduates – could not be extrapolated to other groups. |
| Ferrari, 2020 (61) | To assess the impact of different types of Intradialytic training (IDT) on clinical outcomes and functional parameters in ESRD patients undergoing HD. | Systematic review and metanalysis No details of method of BP measurement. Follow up was 1 day to 12 months for all the 50 studies included. No details are given on the follow up of the studies which look at BP | 10 studies included looked at the effect of aerobic exercise on BP, 2 studies looked at the effect of combined exercise on BP (actual numbers of patients not given) Authors from Brazil, studies included from a variety of countries. HD | Primary outcomes were a range of clinical and functional parameters including BP m | Aerobic IDT reduced SBP MD − 10.07 mmHg (-16.35 to -3.78) I2 44% p= 0.002. but there was a large heterogenicity. Combined training reduced DBP MD − 5.76 mmHg (-8.83 to -2.7) I2 0% p 0.0002. There was a non-significant reduction in SBP -4.33 mmHg (-9.75 to 1.08 p=0.12 This trial only looked at intradialytic exercise. Only 2 studies in combined exercise analysis. |
| Kauric-Klein, 2017 (65) | Examined the effects of an educative, self-regulation intervention on blood pressure self-efficacy, self-care outcomes, and blood pressure control in adults receiving haemodialysis. | Randomised controlled trial Follow-up 12 weeks. BP was measured pre-dialysis and average weekly systolic and diastolic pressure was calculated | 118 HD patient from 6 HD units in Detroit USA. With high BP and on HD for >6 months. 86% African Americans | BP education sessions 2x 15 min sessions, 12 wks of individual counselling. Participants kept: BP log, Na checklist, fluid log, an 11 item BP self-efficacy scale was undertaken at baseline and 12 weeks. | No overall improvement in BP self-efficacy scores. No overall improvement in BP. BP self-efficacy scores were related to lower average diastolic BPs at baseline (r = −.21, p < .001) and at 12 weeks (r = −.318, p < .001) Poor adherence to some aspects only 11% of Na logs were completed. |
| Marx, 2017 (58) | To investigate if polyphenol rich interventions can improve cardiovascular risk markers in HD patient | systematic review and meta-analysis no details on methods to assess BP fup 30 days to 12 months | A subset of 3 studies, 115 participants looked at the effect of polyphenols on blood pressure. HD patients Australia (authors) Studies included from Germany, Israel, USA HD | Primary analysis were lipid profile, inflammation, oxidative stress and blood pressure | Improvement in DBP (MD −5.62 mmHg (95% CI −8.47, −2.78); I2 = 2%; p = 0.0001; but not SBP (MD mmHg −10.02 (95% CI −21.39, 1.35); I2 = 66%; p = 0.08; |
| Mc Causland, 2012 (43) | To determine the effect of dietary sodium intake on blood pressure and mortality | A post-hoc analysis of 1770 patients in the HEMO Study with available dietary, clinical, and laboratory information. Median follow-up time was 2.1 years | 1770 patients 772 were men, 1113 black, and 786 diabetic, with a mean age of 58 years and a median dietary sodium intake of 2080 mg/day HD patients in the HEMO study | Linear regression modelling to determine the effect of dietary sodium intake on blood pressure and mortality | No indices were associated with the pre-dialysis systolic blood pressure. Higher baseline dietary sodium and the ratio of sodium to calorie or potassium were each independently associated with greater all-cause mortality. Higher reported dietary sodium intake was independently associated with greater mortality among prevalent haemodialysis patients. Randomized trials will be necessary to determine whether dietary sodium restriction improves survival. |
| McMahon, 2021 (53) | To determine the effect of two or more levels of salt intake on outcomes in people with any stage of CKD | Systematic review and meta-analysis of RCTs of salt reduction in CKD Subgroup analysis in dialysis patients (5 studies, 149 participants) Where more than one BP measurement was reported, 24‐hour ambulatory BP was used preferentially in analyses and clinic‐assessed BP was used preferentially over self‐assessed BP measurements. | 149 in relevant sub-group analysis Canada HD | Effect of salt reduction death and cardiovascular death and CKD progression Secondary outcomes include effect of salt reduction on blood pressure Subgroup analysis of salt reduction on BP in dialysis patients | In dialysis patients, reducing salt intake reduced both systolic (Analysis 1.2.2 (5 studies, 149 participants): MD ‐ 6.32 mm Hg, 95% CI ‐11.04 to ‐1.60; I² = 0%) and diastolic BP (Analysis 1.3.2 (5 studies, 149 participants): MD ‐3.46 mm Hg, 95% CI ‐6.39 to ‐0.54; I² = 0%). |
| Ozkahya, 1998 (51) | To determine the effect of persistent strict volume control by ultrafiltration alone on LVH | Uncontrolled retrospective observational study BP mean of three consecutive pre-dialysis recordings Follow-up period mean 37±15 months | 15 Turkey HD patients with a previous echocardiographic assessment in the preceding 1.5 years | The effect of ultrafiltration on BP control and LVMI | Mean pre-dialysis BP values of the study group were 139±20/83±11 mmHg at the beginning and 116± 12/73±7 mmHg at the end of observation period. Corresponding post-dialysis values were 126±8/75± 10 mmHg and 105±7/65±3 mmHg respectively The reduction in BP was achieved by diet and fluid advice and ultrafiltation and was associated with a reduction in LVMI from 175±60 to 105±11 g/m2. |
| Pu, 2019 (60) | To assess the efficacy and safety of intradialytic exercise for haemodialysis patients | systematic review and meta-analysis. No details on method of BP measurement. Follow-up: at least 7 weeks | 27 RCTs involving 1215 subjects. 7 of these trials, 287 subjects compared BP of those who exercised for a min of 7 weeks with control (no exercise). Cycling was the exercise in the trials which looked at BP. Authors from China, studies included from a variety of countries. HD | Primary outcomes were dialysis adequacy, VO2 peak, QOL, depression and adverse event. There were a number of secondary outcomes including blood pressure at rest | Intradialytic exercise (cycling) reduces SBP (MD −4.87, 95% CI −9.20 to –0.55, p=0.03) and DBP (MD −4.11, 95% CI −6.50 to –1.72, p=0.0007). no increase in intradialytic hypotension |
| Scapini, 2019 (193) | A systematic review to investigate if aerobic, resistance and combined exercise training improve aerobic capacity, arterial blood pressure and haemodialysis efficiency in people requiring haemodialysis. Is one exercise training modality better than the others? | Systematic review and metanalysis of trials of inter and intra dialytic exercise. Systolic and diastolic arterial pressures at rest. 12wks – 12 months | 16 studies included total of 496 participants. Authors from Brazil, Studies included from variety of countries. HD | Primary outcomes were aerobic capacity, arterial blood pressure at rest and haemodialysis efficiency | Combined training significantly reduced systolic (−9 mmHg, 95% CI −13 to −4) and diastolic (−5 mmHg, 95% CI −6 to −3) blood pressure compared to control Combined training (aerobic and resistance) was found to lower blood pressure but not aerobic alone. |
| Song, 2022 (63) | To determine the most effective exercise intensity and modality for improvements in physical function, blood pressure control, dialysis adequacy, and health-related quality of life for haemodialysis patients | Bayesian network meta-analysis and systematic review No details on method of BP measurement. Follow up of 8 to 40 weeks for the 46 studies included, No details for the follow up just those studies which looked at BP | HD, 46 studies, 1893 participants 21 studies looked at the effect of exercise modality and 19 exercise intensity on BP. Authors from China, studies included from a variety of countries. HD | The 6 minute walk test, Kt/V, systolic and diastolic blood pressure and the short-form 36 health questionnaire (physical and mental health scores compared separately) | No exercise modality significantly reduced SBP or DBP more than the control group. Moderate–vigorous exercise significantly reduced SBP(MD = −8.7, 95% CI = −17 to −1.6, I2 = 70.8%) and DBP (MD = −4.9, 95% CI = −9.9 to −0.35, I2 = 74.2%) than the control group |
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