A Cross-sectional Study on Intradialytic Hypertension at Four Haemodialysis Units in the Western Cape

May 6, 2014 updated by: Mogamat-Yazied Chothia, University of Stellenbosch

A Cross-sectional Study on Intradialytic Hypertension at Four Haemodialysis Units in the Western Cape, South Africa

Observational evidence indicates that intradialytic hypertension is associated with high morbidity & mortality. The investigators impression is that this problem may be more prevalent than initially suspected. To the investigators knowledge, there are no studies on intradialytic hypertension in the South African haemodialysis population.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Detailed Description

Introduction

Intradialytic hypertension (IDH) is the paradoxical rise in blood pressure (BP) during or immediately after haemodialysis.

Nephrologists have yet to arrive at a standard definition of IDH. Definitions vary widely from systolic blood pressure rises of ≥ 10mmHg, rise in mean arterial pressure (MAP) during dialysis > 15mmHg to hypertension that appears resistant to ultrafiltration during or immediately after dialysis.1 Depending on the definition used, the prevalence of IDH varies between 5-15%.

This phenomenon may appear trivial to the inexperienced doctor. However, IDH increases the risk of hospitalization and death as reported in the Crit-Line Intradialytic Monitoring Benefit Study (CLIMB) and United States Renal Data System (USRDS) haemodialysis study.

The pathogenesis of IDH is unclear. A number of factors have been implicated and probably work synergistically to promote the rise in BP. These include: subclinical volume overload, activation of the sympathetic and renin-angiotensin-aldosterone systems, endothelial dysfunction, sodium gain during dialysis, use of erythropoietin stimulating agents (ESAs) and removal of anti-hypertensive agents during dialysis.

The management of IDH relies heavily on control of sodium and fluid dynamics. There are no randomized controlled studies to guide management.

Objectives

Primary: Determine the prevalence of IDH at four haemodialysis units in the Western Cape

Secondary: To examine the association between IDH and the following potential risk factors:

Intradialytic weight gain, the presence and/or degree of fluid overload as assessed by bioimpedance monitoring, quantity and timing of anti-hypertensive drugs, ESA dose and route of administration, time-averaged sodium concentration, dialysate calcium concentrations and haemodialysis modality.

Methods

Study Design

A multicentre, cross-sectional study on chronic haemodialysis patients at four adult dialysis units in the Western Cape will be conducted.IDH will be defined as a rise of ≥10mmHg in systolic blood pressure between pre- and post-dialysis in at least 4 out of six dialysis sessions. Patients screened as eligible for inclusion in the study will be identified from haemodialysis charts by the primary investigator (PI). They will then be approached by the PI, who will try to obtain informed consent. Once informed consent has been obtained and no exclusion criteria are present, the patient will be enrolled. A study ID number will be allocated.

Using a standard operating protocol (SOP), weight, BP, pulse rate, bioimpedance, ultrafiltration rates and volumes will be determined before, hourly during dialysis and 30 minutes after completion of dialysis. Timing and use of antihypertensive drugs, ESA use, dialysis modality, intradialytic calcium and time averaged sodium levels will be determined. All data extracted will be captured onto a standardised data sheet.

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
200

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • South Africa
    • Western Cape
      • Cape Town, Western Cape, South Africa, 7505
        • Tygerberg Academic Hospital

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

14 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

No

Genders Eligible for Study

All

Sampling Method

Non-Probability Sample

Study Population

Chronic haemodialysis patients

Description

Inclusion Criteria:

  • Males and females age > 18 years
  • Ability to give informed consent

Exclusion Criteria:

  • Inability to take blood pressure by routine methods in the upper limbs
  • Inability to give informed consent
  • Contraindications to bioimpedance monitoring (pre-existing implanted cardiac devices such as pacemakers, cardioverter defibrillators; amputees)
  • Intercurrent acute illness

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Observational Models: Case-Control
  • Time Perspectives: Cross-Sectional

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Time Frame
Prevalence of intradialytic hypertension at four haemodialysis units in the Western Cape
Time Frame: Up to 1 year
Up to 1 year

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Time Frame
Participants pre- and post hemodialysis bioimpedance measurements
Time Frame: Up to 1 year
Up to 1 year

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
University of Stellenbosch

Investigators

Investigators

A researcher involved in a clinical study. Related terms include site principal investigator, site sub-investigator, study chair, study director, and study principal investigator.
  • Principal Investigator: Mogamat-Yazied Dr Chothia, FCP(SA), University of Stellenbosch

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
April 1, 2013

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
April 1, 2014

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
May 1, 2014

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
February 1, 2013

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
August 1, 2013

First Posted (Estimate)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
August 5, 2013

Study Record Updates

Last Update Posted (Estimate)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
May 7, 2014

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
May 6, 2014

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
May 1, 2014

More Information

Terms related to this study

Additional Relevant MeSH Terms

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • S12/10/264

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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