Abstract / Summary
Abstract Background Intradialytic hypertension (IDH) is a paradoxical increase in blood pressure during or immediately after hemodialysis and is associated with adverse cardiovascular outcomes. The reported prevalence varies substantially because no single diagnostic definition is universally applied. In this study, the prevalence of IDH was estimated using three reproducible definitions across six consecutive maintenance hemodialysis sessions. Methods This single-center cross-sectional analysis included 280 adults receiving maintenance hemodialysis. Pre- and post-dialysis systolic blood pressure (SBP) was evaluated over six consecutive sessions. IDH was defined as follows: A, any pre-to-post SBP increase in at least four of six sessions; B, an increase in the SBP ≥ 10 mmHg in at least four sessions; and C, an increase in the SBP ≥ 10 mmHg with a post-dialysis SBP ≥ 140 mmHg in at least four sessions. Prevalence was reported with Wilson 95% confidence intervals (CIs), and agreement was assessed using Cohen’s kappa. Results The mean age was 49.5 ± 14.6 years; 168 (60.0%) participants were male, and 112 (40.0%) had diabetes mellitus. The mean session-averaged SBP increased from 138.7 ± 7.6 mmHg before dialysis to 146.1 ± 12.1 mmHg after dialysis. The prevalence was 69.6% (195/280; 95% CI 64.0–74.7) under definitions A and B and 60.0% (168/280; 95% CI 54.2–65.6) under definition C. Definitions A and B showed complete agreement (κ = 1.00); each agreed with definition C in 90.4% of participants (κ = 0.79). Conclusions The estimated IDH prevalence was high and decreased by 9.6 percentage points when a hypertensive-range post-dialysis threshold was met. The identical classification produced by definitions A and B reflects the polarized BP trajectories in this dataset. These findings underscore the importance of reporting precise operational criteria and validating source data before clinical interpretation.