Blood pressure control and symptomatic intradialytic hypotension in diabetic haemodialysis patients: a cross-sectional survey.

Background: Cardiovascular disease remains the most common cause of mortality in end-stage kidney failure patients with diabetes. To improve blood pressure control, and reduce cardiovascular risk, in 2002 the UK Renal Association Standards' Committee introduced pre- and post-dialysis target blood pressures of <140/90 and <130/80 mm Hg, respectively.

Methods: We audited blood pressure control and symptomatic intradialytic hypotension during 1 week in the eleven renal centres in the Greater London Urban Area in 2,193 patients, capturing 6,579 haemodialysis sessions.

Results: Although 73.9% of the 658 diabetic patients were prescribed antihypertensive medications, compared to 57.8% of the 1,535 non-diabetic patients (p < 0.001), both the mean pre- and post-dialysis blood pressures were greater in the diabetic patients: before dialysis 152 +/- 23/77 +/- 13 versus 144 +/- 23/79 +/- 13 mm Hg and after dialysis 138 +/- 24/71 +/- 12 versus 132 +/- 26/73 +/- 13 mm Hg, and fewer diabetic patients achieved the pre- and post-dialysis blood pressure targets: 28.6 versus 40.8% and 37.9 versus 46.3%, respectively (p < 0.01). In addition, more diabetic patients suffered symptomatic intradialytic hypotension, 20.3 versus 14.9% (p < 0.01), associated with greater interdialytic weight gains.

Conclusion: Diabetic haemodialysis patients had higher blood pressures, both before and after dialysis, associated with greater interdialytic weight gains and more frequent symptomatic intradialytic hypotension.