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Updated: Apr 11, 2026
Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
Pro: Ambulatory blood pressure should be used in all patients on hemodialysis
1Department of Medicine, Indiana University School of Medicine and Richard L. Roudebush Veterans Administration Medical Center, Indianapolis, IN, USA.
Insights
Ambulatory blood pressure monitoring (ABPM) is crucial for diagnosing and managing hypertension in hemodialysis patients. This method offers superior accuracy over traditional clinic readings for assessing cardiovascular risk and guiding treatment.
Area of Science:
- Nephrology
- Cardiology
- Hypertension Management
Background:
- Hypertension is a key factor in chronic kidney disease progression and cardiovascular complications.
- Accurate hypertension diagnosis in hemodialysis patients is challenging due to reliance on clinic blood pressure readings.
- Cardiovascular morbidity and mortality in dialysis patients remain areas of debate, partly due to diagnostic limitations.
Purpose of the Study:
- To advocate for the systematic use of ambulatory blood pressure recordings in all hemodialysis patients.
- To highlight the limitations of traditional blood pressure measurements in this population.
- To emphasize the benefits of out-of-office blood pressure monitoring for diagnosis and management.
Main Methods:
- Discussion and defense of the systematic application of ambulatory blood pressure monitoring (ABPM).
- Comparison of ABPM accuracy against standard pre-dialysis and post-dialysis blood pressure measurements.
- Review of the established benefits of out-of-office blood pressure recordings in hypertension management.
Main Results:
- Ambulatory blood pressure recordings are superior to clinic readings for diagnosing hypertension.
- Out-of-office measurements aid in assessing target organ damage and patient prognosis.
- Systematic ABPM can overcome barriers to identifying hypertension as a risk factor in dialysis patients.
Conclusions:
- Ambulatory blood pressure monitoring should be systematically implemented for all hemodialysis patients.
- This approach improves hypertension diagnosis, risk assessment, and patient management.
- Accurate blood pressure monitoring is essential for reducing cardiovascular events in this vulnerable population.
Abstract:
In the adult population in general and among people with chronic kidney disease in particular, it is now well established that hypertension is a major driver of renal disease progression and cardiovascular morbidity and mortality. Although the contribution of hypertension to cardiovascular morbidity and mortality among patients on long-term dialysis continues to be debated, a major barrier to detect hypertension as a risk factor for cardiovascular events in these patients has been the inability to diagnose hypertension. Largely to blame has been the easy availability of pre-dialysis and post-dialysis blood pressure recordings in stark contrast to ambulatory blood pressure measurements in dialysis patients to accurately diagnose the presence or control of hypertension. It is increasingly becoming clear that out-of-office blood pressure recordings are superior to clinic recordings in making a diagnosis, assessing target organ damage, evaluating prognosis and managing patients with hypertension. In this debate, I have been asked to defend the position that ambulatory blood pressure recordings should be systematically applied to all patients on hemodialysis.
Related Concept Videos
01:25Hemodialysis III: Nursing Management
01:24Hemodialysis II: Procedure and Complications
01:28Special considerations while measuring blood pressure
Monitoring Both Arms:
Monitoring BP in both arms during the initial assessment is advisable, as the systolic value may differ by five to ten mm Hg between arms. For subsequent BP assessments, use the arm with the higher reading.
01:25Hemodialysis I: Introduction
01:19Assessing Blood pressure using a doppler ultrasound
Pre-Procedural Guidelines for Doppler Ultrasound Blood Pressure Assessment:
Preparation of Equipment:
01:10Pre-Procedural Guidelines for Assessing Blood Pressure