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Published on: October 2, 2020
Association of Dialysis Shift with Morning Surge in Blood Pressure and Dipping Pattern
Marieta P Theodorakopoulou1, Fotini Iatridi1, Artemios G Karagiannidis1
1First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Insights
Morning hemodialysis is linked to a higher blood pressure surge, increasing cardiovascular risk. This study suggests individualizing dialysis timing based on patient circadian blood pressure patterns.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Circadian Biology
Background:
- Blood pressure exhibits a diurnal pattern, crucial for cardiovascular health.
- An exaggerated morning blood pressure surge is a known risk factor for cardiovascular events.
- The impact of dialysis timing on morning blood pressure surges remains under-investigated.
Purpose of the Study:
- To investigate the association between the timing of hemodialysis and the morning blood pressure surge.
- To compare morning blood pressure surges in patients undergoing morning versus midday/evening hemodialysis shifts.
Main Methods:
- A case-control study involving 226 hemodialysis patients (113 morning shift, 113 midday/evening shift).
- Patients were age- and sex-matched.
- Utilized 48-hour ambulatory blood pressure monitoring to assess morning blood pressure surges using three distinct definitions.
Main Results:
- Morning shift hemodialysis patients demonstrated significantly higher mean sleep-through systolic and diastolic blood pressure surges.
- Higher pre-awakening systolic and diastolic blood pressure surges were also observed in the morning shift group.
- No significant differences were found in the mean rising blood pressure surge or dipping patterns between the groups.
Conclusions:
- Hemodialysis initiated in the morning is associated with a significantly greater morning blood pressure surge.
- Findings suggest a potential need for personalized dialysis scheduling based on individual circadian blood pressure profiles.
- Further research is warranted to confirm these findings and explore clinical implications.
Background:
Blood pressure (BP) presents a diurnal pattern with a nocturnal decrease and an increase in early morning. Evidence suggests that an exaggerated morning BP surge is associated with higher cardiovascular risk. This is the first study evaluating the association between dialysis timing and morning BP surge in hemodialysis.
Methods:
One hundred thirteen patients dialyzed on the morning shift were age- and sex-matched in a 1:1 ratio with 113 patients dialyzed on the midday/evening shifts. All patients underwent 48-hour ambulatory BP monitoring. Morning BP surge at the first and second days of the recording was calculated using three definitions: pre-awakening, sleep-trough, and rising morning BP surge.
Results:
The two groups were similar in terms of age, BMI, and comorbidities. Morning shift patients presented higher mean sleep-through SBP/DBP surges (SBP: 18.71 ± 13.11 vs 14.22 ± 10.25 mmHg, P = .005; DBP: 12.05 ± 8.04 vs 9.46 ± 8.53 mmHg, P = .020) and higher mean pre-awakening SBP/DBP surges (SBP: 12.05 ± 8.04 vs 9.46 ± 8.53 mmHg, P = .020; DBP: 10.16 ± 9.56 vs 6.53 ± 10.78 mmHg, P = .008). No between-groups differences were observed in mean rising SBP surge. During the first 24-hour period, morning shift patients showed higher pre-awakening SBP/DBP surges (SBP: 9.85 ± 11.15 vs 6.22 ± 11.77 mmHg, P = .018) and, during the second 24-hour period, higher sleep-through SBP/DBP surges (SBP: 20.02 ± 18.17 vs 12.79 ± 12.91 mmHg, P = .001; DBP: 12.49 ± 10.76 vs 9.64 ± 10.53, P = .046). Dipping patterns did not differ between groups.
Conclusions:
Patients dialyzed on the morning shift exhibited significantly higher morning BP surge compared to the other two shifts. Future studies should confirm these observations and examine the need for individualizing the choice of dialysis shift for patients with specific circadian BP profiles.
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