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The ISN Clinical Practice Guidelines Committee
The ISN Clinical Practice Guidelines Committee
Nature Clinical Practice Nephrology 4, 463 (2008). doi:10.1038/ncpneph0905
Authors: Gavin J Becker, Omar Abboud, Ezequiel Bellorin-Font, Michael Field, Philip KT Li, Richard J Johnson
& Christoph Wanner
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Diagnosing Hypertension by Intradialytic Blood Pressure Recordings
Background and objectives: The diagnosis of hypertension among hemodialysis patients by predialysis or postdialysis blood pressure (BP) recordings is imprecise and biased and has poor test-retest reliability. The use of intradialytic BP measurements to diagnose hypertension is unknown.
Design, setting, participants, & measurements: A diagnostic-test study was done with interdialytic ambulatory BP as reference standard. Index BP recordings tested were: predialysis (method 1), postdialysis (method 2), intradialytic (method 3), intradialytic including predialyis and postdialysis (method 4), and the average of predialysis and postdialysis (method 5). Each index BP was recorded over six consecutive dialysis treatments.
Results: There were differences among index BP measurements in reproducibility, bias, precision, and accuracy. Method 4 was the most reproducible (intraclass correlation coefficient = 0.70 for systolic and diastolic BP). All 5 measurement methods overestimated 44-h ambulatory systolic BP. Methods 2, 3, or 4 overestimated ambulatory systolic BP by only a small amount. Method 4 was the most precise and accurate. For diagnosis of hypertension, BP cut-point by method 4 of 135/75 mmHg, had a sensitivity of 90.4% and specificity of 75.9% for systolic BP (area under ROC curve 0.90). Median cut-off systolic BP of 140 mmHg from a single dialysis provides approximately 80% sensitivity and 80% specificity in diagnosing systolic hypertension; a median cut-off diastolic BP of 80 mmHg provides approximately 75% sensitivity and 75% specificity in diagnosing diastolic hypertension.
Conclusions: Consideration of intradialytic BP measurements together with predialysis and postdialysis BP measurements improves the reproducibility, bias, precision, and accuracy of BP measurement compared with predialysis or postdialysis measurements.
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Hand Hygiene: How Can We Improve?
Lisa Maragakis, MD, reviews in her videoblog the serious challenges of measuring and improving hand hygiene compliance in the healthcare setting.
Medscape Infectious Diseases
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Want to live longer? Take the stairs instead of the elevator.
BBC: Over the 12 weeks of the study, the volunteers, who were hospital employees at the university, were asked to use the stairs exclusively at work instead of taking the lift.
On average, the number of flights of stairs - classed as climbing up or down one storey - rose from five per day to 23.
After the three months of the trial, tests showed they had better lung capacity, blood pressure and cholesterol measurements.
Their weight, body fat and waist measurements also dropped, and their capacity for doing aerobic exercise improved.
Taken together, this equates to a 15% reduction in the chances of dying young, say the investigators.
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Pediatric Nephrologist Joins Medical College of Wisconsin Faculty - AScribe (press release)
