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Factors Influencing Blood Pressure Variability in Hemodialysis Patients
Abstract
Background: Blood pressure changes during hemodialysis are a common complication and can profoundly impact patient safety and quality of life. Various factors such as individual characteristics, technical aspects of the dialysis procedure, and psychological conditions are suspected to contribute to these blood pressure variability. Objective: This study aims to analyze the relationship between age, dialysis vintage, interdialytic weight gain (IDWG), blood flow rate (BFR), and stress levels with blood pressure variability in hemodialysis patients. Methods: This study uses a cross-sectional design with a quantitative approach. Fifty hemodialysis patients who met the inclusion criteria were selected as respondents. Data were collected through clinical dialysis observation sheets, pre-post dialysis blood pressure measurements, and stress level questionnaires. Data analysis was performed using the chi-square test. Data analysis was performed using the chi-square test. Results: The results showed that 54% of patients experienced changes in blood pressure after hemodialysis. There was a significant relationship between age (p = 0.008), IDWG (p = 0.003), BFR (p = 0.027), and stress levels (p = 0.002) with changes in blood pressure. Meanwhile, the dialysis vintage did not show a significant relationship (p = 0.569). Conclusion: Variability in blood pressure during hemodialysis are influenced by physiological, technical, and psychological factors. Managing hemodialysis patients requires a holistic and individual approach, including IDWG management, BFR adjustment, and stress management. Further research is recommended with a longitudinal design and a larger sample coverage.
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Assimon, M. M., Wang, L., & Flythe, J. E. (2018). Intradialytic Hypertension Frequency and Short-Term Clinical Outcomes Among Individuals Receiving Maintenance Hemodialysis. American Journal of Hypertension, 31(3), 329–339. https://doi.org/10.1093/AJH/HPX186
Badan Kebijakan Pembangunan Kesehatan Republik Indonesia. (2023). Survei Kesehatan Indonesia (2023) Dalam Angka: Data Akurat Kebijakan Tepat. https://layanandata.kemkes.go.id/katalog-data/ski/ketersediaan-data/ski-2023
Bello, A. K., Okpechi, I. G., Levin, A., Ye, F., Saad, S., Zaidi, D., Houston, G., Damster, S., Arruebo, S., Abu Alfa, A., Ashuntantang, G., Caskey, F. J., Cho, Y., Coppo, R., Davids, M. R., Davidson, S., Gaipov, A., Htay, H., Jindal, K., & Johnson, D. W. (2023). Global Kidney Health Atlas 2023. www.theisn.org/global-atlas
Bikbov, B., Purcell, C., Levey, A. S., Smith, M., Abdoli, A., Abebe, M., Adebayo, O. M., Afarideh, M., Agarwal, S. K., Agudelo-Botero, M., Ahmadian, E., Al-Aly, Z., Alipour, V., Almasi-Hashiani, A., Al-Raddadi, R. M., Alvis-Guzman, N., Amini, S., Andrei, T., Andrei, C. L., … Vos, T. (2020). Global, regional, and national burden of chronic kidney disease, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017. The Lancet, 395(10225), 709–733. https://doi.org/10.1016/S0140-6736(20)30045-3/ATTACHMENT/EED2EC89-72F4-4F77-875F-002E37B6E474/MMC1.PDF
Bossola, M., Angioletti, L., Di Giovanni, M., Mariani, I., Di Stasio, E., & Balconi, M. (2025). Perceived Stress Is Linked to Depression but Not to Clinical Outcomes in Maintenance Hemodialysis Patients. Journal of Clinical Medicine 2025, Vol. 14, Page 883, 14(3), 883. https://doi.org/10.3390/JCM14030883
Bowman, B., & Rosner, M. H. (2018). Acute Complications of Hemodialysis. In Chronic Kidney Disease, Dialysis, and Transplantation: A Companion to Brenner and Rector’s The Kidney (pp. 411-426.e6). Elsevier. https://doi.org/10.1016/B978-0-323-52978-5.00026-4
Daugirdas, J., Blake, P., & Ing, T. (2015). Handbook of Dialysis (5th ed.). In Faculty Bookshelf. Wolters Kluwer Health. https://hsrc.himmelfarb.gwu.edu/books/23
Diakité, F., Baldé, M. S., Koné, A., Traoré, M., Chérif, I., Bah, A. B., Diaby, M. T., Bah, A. O., Kaba, M. L., Diakité, F., Baldé, M. S., Koné, A., Traoré, M., Chérif, I., Bah, A. B., Diaby, M. T., Bah, A. O., & Kaba, M. L. (2020). Intradialytic Hypertension and Associated Factors in Chronic Hemodialysis at the National Hemodidiadiasis Center in Donka, Guinea. Open Journal of Nephrology, 10(1), 34–42. https://doi.org/10.4236/OJNEPH.2020.101005
Douvris, A., Malhi, G., Hiremath, S., McIntyre, L., Silver, S. A., Bagshaw, S. M., Wald, R., Ronco, C., Sikora, L., Weber, C., & Clark, E. G. (2018). Interventions to prevent hemodynamic instability during renal replacement therapy in critically ill patients: a systematic review. Critical Care (London, England), 22(1). https://doi.org/10.1186/S13054-018-1965-5
Dugilo, J. R., Bakshi, F., Abeid, M., & Somji, S. (2025). Frequency, predictors and outcomes of intradialytic complications in patients on maintenance haemodialysis in Dar es Salaam: Prospective longitudinal study. PLOS ONE, 20(3), e0300823. https://doi.org/10.1371/JOURNAL.PONE.0300823
Fadlilah, S., Sucipto, A., & Rahil, N. H. (2020). The relationship between blood flow rate and changes in blood pressure of patients during hemodialysis in Central Java, Indonesia. Https://Wjarr.Com/Sites/Default/Files/WJARR-2020-0005.Pdf, 5(2), 001–006. https://doi.org/10.30574/WJARR.2020.5.2.0005
Fiore, G. B., & Ronco, C. (2007). Principles and practice of internal hemodiafiltration. Contributions to Nephrology, 158, 177–184. https://doi.org/10.1159/0000107248
Flythe, J. E., Kunaparaju, S., Dinesh, K., Cape, K., Feldman, H. I., & Brunelli, S. M. (2012). Factors Associated With Intradialytic Systolic Blood Pressure Variability. American Journal of Kidney Diseases, 59(3), 409–418. https://doi.org/10.1053/J.AJKD.2011.11.026
Flythe, J. E., Xue, H., Lynch, K. E., Curhan, G. C., & Brunelli, S. M. (2015). Association of mortality risk with various definitions of intradialytic hypotension. Journal of the American Society of Nephrology : JASN, 26(3), 724–734. https://doi.org/10.1681/ASN.2014020222
Hakim, Moh. A., & Aristawati, N. V. (2023). Measuring depression, anxiety, and stress in early adults in Indonesia: Construct validity and reliability test of DASS-21. Jurnal Psikologi Ulayat, 10(2), 232–250. https://doi.org/10.24854/JPU553
Halle, M. P., Hilaire, D., Francois, K. F., Denis, T., Hermine, F., & Gloria, A. E. (2020). Intradialytic hypotension and associated factors among patients on maintenance hemodialysis: A single-center study in cameroon. Saudi Journal of Kidney Diseases and Transplantation : An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 31(1), 215–223. https://doi.org/10.4103/1319-2442.279944
Hamrahian, S. M., Vilayet, S., Herberth, J., & Fülöp, T. (2023). Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects. International Journal of Nephrology and Renovascular Disease, 16, 173. https://doi.org/10.2147/IJNRD.S245621
Harvey, A., Montezano, A. C., & Touyz, R. M. (2015). Vascular biology of ageing—Implications in hypertension. Journal of Molecular and Cellular Cardiology, 83, 112–121. https://doi.org/10.1016/J.YJMCC.2015.04.011
Hering, D., Lachowska, K., & Schlaich, M. (2015). Role of the Sympathetic Nervous System in Stress-Mediated Cardiovascular Disease. Current Hypertension Reports, 17(10), 1–9. https://doi.org/10.1007/S11906-015-0594-5/FIGURES/2
Inrig, J. K., Patel, U. D., Gillespie, B. S., Hasselblad, V., Himmelfarb, J., Reddan, D., Lindsay, R. M., Winchester, J. F., Stivelman, J., Toto, R., & Szczech, L. A. (2007). Relationship Between Interdialytic Weight Gain and Blood Pressure Among Prevalent Hemodialysis Patients. American Journal of Kidney Diseases : The Official Journal of the National Kidney Foundation, 50(1), 108. https://doi.org/10.1053/J.AJKD.2007.04.020
Jager, K. J., Kovesdy, C., Langham, R., Rosenberg, M., Jha, V., & Zoccali, C. (2019). A single number for advocacy and communication-worldwide more than 850 million individuals have kidney diseases. Kidney International, 96(5), 1048–1050. https://doi.org/10.1016/j.kint.2019.07.012
Jha, V., Garcia-Garcia, G., Iseki, K., Li, Z., Naicker, S., Plattner, B., Saran, R., Wang, A. Y. M., & Yang, C. W. (2013). Chronic kidney disease: global dimension and perspectives. Lancet (London, England), 382(9888), 260–272. https://doi.org/10.1016/S0140-6736(13)60687-X
Kidney Disease Improving Global Outcome/ KDIGO. (2017). KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Journal Of The International Society of Nephrology, 7(1), 1–59. https://kdigo.org/wp-content/uploads/2017/02/2017-KDIGO-CKD-MBD-GL-Update.pdf
Kinanthi, M. R., Listtiyandini, R. A., Amaliah, U. S., & Ramadhanty, R. (2020). Adaptasi Alat Ukur DASS-21 Versi Indonesia pada Populasi Mahasiswa | Request PDF. Seminar Nasional Psikologi Dan Call for Paper UMB Yogyakarta 2020 At: Universitas Mercu Buana Yogyakarta. https://www.researchgate.net/publication/339616412_Adaptasi_Alat_Ukur_DASS-21_Versi_Indonesia_pada_Populasi_Mahasiswa
Kovesdy, C. P. (2022). Epidemiology of chronic kidney disease: an update 2022. Kidney International Supplements, 12(1), 7–11. https://doi.org/10.1016/J.KISU.2021.11.003
Lee, M. J., Doh, F. M., Kim, C. H., Koo, H. M., Oh, H. J., Park, J. T., Han, S. H., Yoo, T. H., Kim, Y. L., Kim, Y. S., Yang, C. W., Kim, N. H., & Kang, S. W. (2014). Interdialytic weight gain and cardiovascular outcome in incident hemodialysis patients. American Journal of Nephrology, 39(5), 427–435. https://doi.org/10.1159/000362743
Leung, K. C. W., Quinn, R. R., Ravani, P., Duff, H., & Macrae, J. M. (2017). Randomized crossover trial of blood volume monitoring–guided ultrafiltration biofeedback to reduce intradialytic hypotensive episodes with hemodialysis. Clinical Journal of the American Society of Nephrology, 12(11), 1831–1840. https://doi.org/10.2215/CJN.01030117
Lovibond, S. H. ., & Lovibond, P. F. . (1996). Manual for the depression anxiety stress scales (2nd ed.). Psychology Foundation of Australia. https://books.google.com/books/about/Manual_for_the_Depression_Anxiety_Stress.html?hl=id&id=mXoQHAAACAAJ
Maier, J. A., Andrés, V., Castiglioni, S., Giudici, A., Lau, E. S., Nemcsik, J., Seta, F., Zaninotto, P., Catalano, M., & Hamburg, N. M. (2023). Aging and Vascular Disease: A Multidisciplinary Overview. Journal of Clinical Medicine 2023, Vol. 12, Page 5512, 12(17), 5512. https://doi.org/10.3390/JCM12175512
Mehmood, Y., Ali, I., Zahra, K., & Ashraf, U. (2019). Hemodialysis; acute intradialytic complications found on maintenance hemodialysis in patients at a public hospital lahore. The Professional Medical Journal, 26(01), 45–50. https://doi.org/10.29309/TPMJ/2019.26.01.2511
Morowatisharifabad, M., Ghaffari, M., Mehrabi, Y., Askari, J., Zare, S., & Alizadeh, S. (2020). Experiences of stress appraisal in hemodialysis patients: A theory-guided qualitative content analysis. Saudi Journal of Kidney Diseases and Transplantation : An Official Publication of the Saudi Center for Organ Transplantation, Saudi Arabia, 31(6), 1294–1302. https://doi.org/10.4103/1319-2442.308338
Nongnuch, A., Campbell, N., Stern, E., El-Kateb, S., Fuentes, L., & Davenport, A. (2015). Increased postdialysis systolic blood pressure is associated with extracellular overhydration in hemodialysis outpatients. Kidney International, 87(2), 452–457. https://doi.org/10.1038/KI.2014.276
Putu, N., Wiraanjani, B., Nyoman, D., & Lestari, D. (2025). A 27-year-old Man with Chronic Kidney Disease and Intradialytic Hypertension, A Review of Psychological Aspects as Risk Factors. International Journal of Psychology and Health Science, 3(1), 256–261. https://doi.org/10.38035/IJPHS.V3I1.790
Ramadhan, M. P., Herawati, T., Adam, M., & Yetti, K. (2023). Interdialytic weight gain levels and blood pressure changes during fluid withdrawal in hemodialysis patients. Journal of Public Health in Africa, 14(2), 5. https://doi.org/10.4081/JPHIA.2023.2566
Rocco, M., Daugirdas, J. T., Depner, T. A., Inrig, J., Mehrotra, R., Rocco, M. V., Suri, R. S., Weiner, D. E., Greer, N., Ishani, A., MacDonald, R., Olson, C., Rutks, I., Slinin, Y., Wilt, T. J., Kramer, H., Choi, M. J., Samaniego-Picota, M., Scheel, P. J., … Brereton, L. (2015). KDOQI Clinical Practice Guideline for Hemodialysis Adequacy: 2015 Update. American Journal of Kidney Diseases, 66(5), 884–930. https://doi.org/10.1053/J.AJKD.2015.07.015
Rohrscheib, M. R., Myers, O. B., Servilla, K. S., Adams, C. D., Miskulin, D., Bedrick, E. J., Hunt, W. C., Lindsey, D. E., Gabaldon, D., & Zager, P. G. (2008). Age-related blood pressure patterns and blood pressure variability among hemodialysis patients. Clinical Journal of the American Society of Nephrology : CJASN, 3(5), 1407–1414. https://doi.org/10.2215/CJN.00110108
Rovin, B. H., Ayoub, I. M., Mao Chan, T., Liu, Z.-H., Manuel Mejía-Vilet, J., & Floege, J. (2024). KDIGO 2024 Clinical Practice Guideline for the management of LUPUS NEPHRITIS. Kidney International, 105(1), S1–S69. https://doi.org/10.1016/J.KINT.2023.09.002/ASSET/E3D905AD-3DFB-4573-93FB-85426F0866CB/MAIN.ASSETS/GR2.JPG
Schytz, P. A., Mace, M. L., Soja, A. M. B., Nilsson, B., Karamperis, N., Kristensen, B., Ladefoged, S. D., & Hansen, H. P. (2015). Impact of extracorporeal blood flow rate on blood pressure, pulse rate and cardiac output during haemodialysis. Nephrology Dialysis Transplantation, 30(12), 2075. https://doi.org/10.1093/NDT/GFV316
Timofte, D., Tanasescu, M.-D., Balan, D. G., Tulin, A., Stiru, O., Vacaroiu, I. A., Mihai, A., Popa, C. C., Cosconel, C.-I., Enyedi, M., Miricescu, D., Papacocea, R. I., & Ionescu, D. (2021). Management of acute intradialytic cardiovascular complications: Updated overview (Review). Experimental and Therapeutic Medicine, 21(3), 282. https://doi.org/10.3892/ETM.2021.9713
Van Buren, P. N., & Inrig, J. K. (2011). Hypertension and hemodialysis: pathophysiology and outcomes in adult and pediatric populations. Pediatric Nephrology (Berlin, Germany), 27(3), 339. https://doi.org/10.1007/S00467-011-1775-3
Van Buren, P. N., & Inrig, J. K. (2017). Special Situations: Intradialytic Hypertension/Chronic Hypertension and Intradialytic Hypotension. Seminars in Dialysis, 30(6), 545. https://doi.org/10.1111/SDI.12631
Wald, R., Shariff, S. Z., Adhikari, N. K. J., Bagshaw, S. M., Burns, K. E. A., Friedrich, J. O., Garg, A. X., Harel, Z., Kitchlu, A., & Ray, J. G. (2014). The association between renal replacement therapy modality and long-term outcomes among critically ill adults with acute kidney injury: a retrospective cohort study*. Critical Care Medicine, 42(4), 868–877. https://doi.org/10.1097/CCM.0000000000000042
Xu, H., Wang, X., Feng, M., & Chen, L. (2024). Characteristics and Influencing Factors of Intra-Dialysis Blood Pressure Variability in Hemodialysis Patients: A Retrospective Study. International Journal of General Medicine, 17, 4781–4791. https://doi.org/10.2147/IJGM.S479035
Zhao, Y., Yang, L., Yu, S., Salerno, S., Li, Y., Cui, T., Zhang, L., & Fu, P. (2020). Blood Pressure Variability and Prognosis in Hemodialysis Patients: A Systematic Review and Meta-Analysis. Kidney Diseases, 7(5), 411. https://doi.org/10.1159/000511295
Zoccali, C., Moissl, U., Chazot, C., Mallamaci, F., Tripepi, G., Arkossy, O., Wabel, P., & Stuard, S. (2017). Chronic Fluid Overload and Mortality in ESRD. Journal of the American Society of Nephrology : JASN, 28(8), 2491–2497. https://doi.org/10.1681/ASN.2016121341
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