Original Article Intradialytic hypertension is a marker of volume excess

Background. Intradialytic blood pressure (BP) profiles have been associated with all-cause mortality, but its path-ophysiology remains unknown. We tested the hypothesis that intradialytic changes in BP reflect excess volume. Methods. The dry weight reduction in hypertensive hae-modialysis patients (DRIP) trial probed dry weight in 100 prevalent haemodialysis patients; 50 patients who did not have their dry weight probed served as time controls. In this post hoc analysis, intradialytic BP was recorded at each of the 30 dialysis treatments during the trial. The slope of intradialytic BP over dialysis was calculated by the log of BP regressed over time. Using a linear mixed model, we compared these slopes between control and ul-trafiltration groups at baseline and over time, tested the effect of dry weight reduction on these slopes and finally tested the ability of change in intradialytic slopes to pre-dict change in interdialytic systolic BP. Results. At baseline, intradialytic systolic and diastolic BP dropped at a rate of ∼3%/h (P < 0.0001). Over the course of the trial, compared to the control group, the slopes steepened in the ultrafiltration group for systolic but not diastolic BP. Those who lost the most post-dialysis weight from baseline to 4 weeks and baseline to 8 weeks also ex-perienced the greatest steepening of slopes. Each percent per hour steepening of the intradialytic systolic BP slope was associated with 0.71 mmHg [95 % confidence interval (CI) 0.01–1.42, P = 0. 048] reduction in interdialytic am-bulatory systolic pressure. Conclusions. Intradialytic BP changes appear to be asso-ciated with change in dry weight among haemodialysis pa-tients. Among long-term haemodialysis patients, intradialytic hypertension may, thus, be a sign of volume overload