POOR TOLERABILITY OF THE STANDARD, EXTENDED, 48H AMBULATORY BLOOD PRESSURE MONITORING IN HEMODIALYSIS PATIENTS

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Objective: 44h or 48h Ambulatory blood pressure monitoring (ABPM) is recommended for diagnosing hypertension in dialysis patients. Because the longer recording period, the notorious sleeping disturbances and the symptom burden of the ESKD population, the feasibility of the technique may be limited in this population. However, its large-scale tolerability of ABPM in hemodialysis patients has never been investigated. Design and method: We performed a survey of the feasibility and tolerability of 48h ABPM in 6 European centres, led by motivated nephrologists members of the EURECA-m working group. 48h ABPM recording was proposed to a representative sample of the dialysis population of these centres. Recordings were made at 15-minute (day) or 30-minute (night) intervals. Reasons for refusal to undergo the test, for not completing the monitoring, and symptoms developed during the ABPM study were systematically recorded. Results: In the whole hemodialysis population of participating centers including 735 patients, 440 (60%) were invited to participate in the study. Among these patients 119 patients (27%) refused to undergo ABPM recording. Reasons for refusal are detailed in the table. Among the 321 patients who performed the 48h ABPM recording, 29 patients (9%) did not complete it and the main reason for interrupting the recording were discomfort (41%) and device failure (34%). Frequent interruption of sleeping because of noise or discomfort was a symptom reported by 32% of patients, followed by itching (24%) and pain during the measurements (20%). The detailed list of symptoms is reported in the table. Conclusions: About 25% of hemodialysis patients consider 48h ABPM a laborious and discomforting test and prejudicially refuse to undergo it. Among patients who undergo 48h ABPM, itching and interruption of sleeping are complained by about 1/3 of patients. These figures are substantially higher than those reported in studies in the general population and in hypertensive patients and point to peculiar barriers at applying extended ABPM recordings in the hemodialysis population. Studies applying more tolerable instruments and a minimum set of measurements over a shorter time are clinical research priority for extending the use of ABPM in the hemodialysis population.

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