Feasibility of the extended, 48-h ambulatory blood pressure monitoring in hemodialysis patients: a multicenter study.

Of 440 invited hemodialysis patients, 119 (27%) refused ABPM or could not undergo recording.

• 440 consecutive adult in-center hemodialysis patients were recruited from eight nephrology units in Italy, Greece, and Slovenia.
• 27% of all invited patients refused or could not undergo ABPM recording before initiation.
• Reasons for refusal or noncompletion were systematically recorded.

Among the 321 patients who initiated 48-h ABPM, 29 (9%) did not complete the protocol and 35 (11%) had inadequate recordings.

• 321 patients initiated the 48-h ABPM protocol.
• 9% of those who started did not complete the protocol.
• 11% of those who started had inadequate recordings (defined as fewer than 70% of measurements obtained).
• ABPM was considered valid if at least 70% of measurements were obtained.

Valid 48-h ABPM was successfully completed by 257 patients, representing 80% of those who started ABPM but only 58% of all invited patients.

• 257 patients completed valid 48-h ABPM recordings.
• This represented 80% of the 321 patients who initiated the protocol.
• This represented 58% of all 440 initially invited patients.
• The study was multicenter, involving eight nephrology units across Italy, Greece, and Slovenia.

The most commonly reported symptoms during 48-h ABPM were sleep interruption, itching, and pain during BP measurements.

• Sleep interruption was reported by 32% of patients.
• Itching was reported by 24% of patients.
• Pain during BP measurements was reported by 20% of patients.
• Tolerability and sleep disturbance were assessed using standardized questionnaires.

Continuous pain and inability to sleep were significantly associated with the 'dipping' BP phenotype.

• The association between symptoms and BP phenotype was assessed among patients who completed valid ABPM recordings.
• Both continuous pain and inability to sleep were significantly associated with the dipping BP phenotype.
• This finding suggests a potential interaction between ABPM-related discomfort and nocturnal BP behavior.

ABPM is recommended as the gold standard for assessing blood pressure in hemodialysis patients because it enables detection of masked and nocturnal hypertension linked to adverse outcomes.

• Masked and nocturnal hypertension are phenomena linked to adverse outcomes in CKD patients on hemodialysis.
• Despite strong guideline recommendations for ABPM in this population, real-world feasibility remained unclear prior to this study.
• The study was designed to assess feasibility and tolerability of extended 48-h ABPM in this frail population.