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Post-dialytic blood pressure in hemodialysis patients: still an inaccurate metric

Hypertension Research volume 48, pages 2012–2013 (2025)Cite this article

(Letter to the Editor for: Bezerra et al. Optimal timing for post-dialysis blood pressure measurement: relationship with home blood pressure monitoring. Hypertens Res 2025, https://doi.org/10.1038/s41440-025-02103-4).

We read with interest the article of Bezerra et al. [1], exploring the validity of post-dialysis blood pressure (BP) at three different time-points against home BP in 210 hemodialysis patients. Studying specifically post-dialysis BP is uncommon and welcomed. However, the study rationale is rather weak. The authors cite a 2004 guideline with an ungraded recommendation of using pre-dialysis and post-dialysis BP, which is long discredited, since numerous studies have conclusively shown that both inaccurately reflect true BP and have very poor associations with outcomes in hemodialysis patients [2,3,4]. Indeed, current recommendations strongly favor the use of ambulatory BP monitoring (ABPM) or home BP measurements for diagnosis and management of BP in this population [5].

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References

  1. Rodrigo Bezerra R, Gorayeb-Polacchini FS, Teles F, Pinto LCS, Tome ACN, Bidoia MP. Optimal timing for post-dialysis blood pressure measurement: relationship with home blood pressure monitoring. Hypertens Res. 2025. https://doi.org/10.1038/s41440-025-02103-4.

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  2. Agarwal R, Peixoto AJ, Santos SFF, Zoccali C. Pre- and postdialysis blood pressures are imprecise estimates of interdialytic ambulatory blood pressure. Clin J Am Soc Nephrol. 2006;1:389–98.

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  3. Sarafidis P, Theodorakopoulou MP, Loutradis C, Iatridi F, Alexandrou M-E, Karpetas A, et al. Accuracy of peridialytic, intradialytic, and scheduled interdialytic recordings in detecting elevated ambulatory blood pressure in hemodialysis patients. Am J Kidney Dis. 2021;78:630–9.

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  4. Iatridi F, Theodorakopoulou MP, Karpetas A, Bikos A, Karagiannidis AG, Alexandrou M-E, et al. Association of peridialytic, intradialytic, scheduled interdialytic and ambulatory BP recordings with cardiovascular events in hemodialysis patients. J Nephrol. 2022;35:943–54.

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  5. Sarafidis PA, Persu A, Agarwal R, Burnier M, de Leeuw P, Ferro C, et al. Hypertension in dialysis patients: a consensus document by the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association – European Dialysis and Transplant Association (ERA-EDTA) and the Hypertension and the Kidney working group of the European Society of Hypertension (ESH). J Hypertens. 2017;35:657–76.

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Authors and Affiliations

  1. First Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece

    Fotini Iatridi, Marieta P. Theodorakopoulou & Pantelis Sarafidis

Authors
  1. Fotini Iatridi
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  2. Marieta P. Theodorakopoulou
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  3. Pantelis Sarafidis
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Correspondence to Fotini Iatridi.

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Iatridi, F., Theodorakopoulou, M.P. & Sarafidis, P. Post-dialytic blood pressure in hemodialysis patients: still an inaccurate metric. Hypertens Res 48, 2012–2013 (2025). https://doi.org/10.1038/s41440-025-02193-0

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