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Meta-Analysis
. 2024 Jun 11;19(6):e0304633.
doi: 10.1371/journal.pone.0304633. eCollection 2024.

The prevalence and risk of mortality associated with intradialytic hypertension among patients with end-stage kidney disease on haemodialysis: A systematic review and meta-analysis

Oluseyi Ademola Adejumo  1 , Imuetinyan Rahsida Edeki  2 , Dapo Sunday Oyedepo  3 , Olawale Elijah Yisau  1 , Olanrewaju Olumide Ige  1 , Inyeneabasi Udeme Ekrikpo  4 , Ayman Sabri Moussa  5 , Hansel Palencia  6 , Jean Jacques Noubiap  7 , Udeme Ekpenyong Ekrikpo  5   8
Affiliations
Meta-Analysis

The prevalence and risk of mortality associated with intradialytic hypertension among patients with end-stage kidney disease on haemodialysis: A systematic review and meta-analysis

Oluseyi Ademola Adejumo et al. PLoS One. .

Abstract

Introduction: Intradialytic hypertension (IDHTN) is a common but less frequently recognised complication of haemodialysis. However, it is associated with increased overall mortality in patients on haemodialysis. This systematic review and meta-analysis aimed to determine the prevalence of IDHTN and associated mortality risk in the global haemodialysis population.

Method: A systematic search of PubMed and EMBASE was undertaken to identify articles with relevant data published between 1990 and 2023. The pooled prevalence of IDHTN in the global haemodialysis population was determined using the DerSimonian-Laird random-effects meta-analysis. The pooled hazards ratio for mortality in patients with IDHTN was also computed from the studies that reported mortality among haemodialysis patients with IDHTN. The study protocol was registered with PROSPERO (CRD42023388278).

Results: Thirty-two articles from 17 countries were included, with a pooled population of 127,080 hemodialysis patients (median age 55.1 years, 38.2% females). Most studies had medium methodological quality (53.1%, n = 17). The overall pooled prevalence of IDHTN was 26.6% [(95% CI 20.2-33.4%), n = 27 studies, I2 = 99.3%, p<0.001 for heterogeneity], with significant differences depending on the definition used. The pooled proportion of haemodialysis sessions with IDHTN was 19.9% [(95% 12.5-28.6%, n = 8 studies, I2 = 99.3%, p<0.001 for heterogeneity)] with significant differences across the different definition criteria. The p-value for the Begg test was 0.85. The median pre-dialysis blood pressure was not significantly associated with IDHTN. The pooled hazard ratio for mortality was 1.37 (95% CI 1.09-1.65), n = 5 studies, I2 = 13.7%, and p-value for heterogeneity = 0.33.

Conclusion: The prevalence of IDHTN is high and varies widely according to the definition used. A consensus definition of IDHTN is needed to promote uniformity in research and management. The increased mortality risk forecasted by IDHTN highlights the need for optimal blood pressure control in patients on hemodialysis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. PRISMA flow chart—Identification and screening of articles.
Fig 2
Fig 2. Forest plot showing the pooled prevalence of IDHTN by definition criteria.
Fig 3
Fig 3. Forest plot showing the pooled hazard ratio for mortality among IDHTN patients.
See this image and copyright information in PMC

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