Blood Pressure and Pulse Rate Changes in Chronic Kidney Disease Patients Before and After Hemodialysis: An Observational Study

Berlian Yuli Saputri, Ketjuk Herminaju, Manggar Purwacaraka, Yoga Resti Awalina, Hasanudin Hasanudin

Abstract


Background: Chronic Kidney Disease (CKD) is a progressive decline in kidney function that leads to the accumulation of metabolic waste products and excess body fluids, causing most patients to require long-term hemodialysis therapy. Hemodialysis may trigger significant hemodynamic changes, including intradialytic hypertension and tachycardia, which can cause serious cardiovascular complications. Objective: This study aimed to analyze changes in blood pressure and pulse rate before and after hemodialysis in patients with CKD at Bhayangkara Tulungagung Hospital. Methods: This study used an observational design with a before-after approach involving 30 respondents selected using a purposive sampling technique. Data were collected using structured observation sheets 15 minutes before and after each hemodialysis session. Data analysis was performed using the Wilcoxon signed-rank test with a significance level of α = 0.05. Results: Before hemodialysis, most respondents were categorized as prehypertensive (50%) with normal pulse rates (76.7%). After hemodialysis, the proportion of hypertension increased from 16.7% to 63.3%, and tachycardia increased from 16.7% to 63.3%. The Wilcoxon signed-rank test showed statistically significant changes in blood pressure and pulse rate before and after hemodialysis (p < 0.001). Conclusion: Hemodialysis was associated with significant hemodynamic changes in patients with CKD, characterized by increased proportions of hypertension and tachycardia. These findings emphasize the importance of systematic hemodynamic monitoring protocols by nurses during hemodialysis sessions to enable the early detection of cardiovascular complications and improve patient safety. Future researchers are encouraged to analyze the factors contributing to hemodynamic changes in patients with CKD


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References


1. Forbes A, Gallagher H. Chronic kidney disease in adults: assessment and management. Clin Med. 2020 Mar;20(2):128–32. https://doi.org/10.7861/clinmed.cg.20.2

Mark PB, Stafford LK, Grams ME, Aalruz H, Abd ElHafeez S, Abdelgalil AA, et al. Global, regional, and national burden of chronic kidney disease in adults, and its attributable risk factors: a systematic analysis for the Global Burden of Disease Study 2023. Lancet. 2025 Nov 22;406(10518):2461–82.

Borg R, Carlson N, Søndergaard J, Persson F. The Growing Challenge of Chronic Kidney Disease: An Overview of Current Knowledge. Int J Nephrol. 2023;2023:9609266. https://doi.org/10.1155/2023/9609266

Hustrini NM. Prevalence and risk factors for chronic kidney disease in Indonesia : An analysis of the National Basic Health Survey 2018. J Glob Health. 2022;12:1–10. https://doi.org/10.7189/jogh.12.04074

Andhika R, Afiatin, Supriyadi R, Bandiara R, Sukesi L, Sudarmadi AP, et al. One-year Survival of End-Stage Kidney Disease Patients Undergoing Hemodialysis in Indonesia. Int J Nephrol Renov Dis Int. 2025;(March):87–101. https://doi.org/10.2147/IJNRD.S508012

Thajudeen B, Issa D, Roy-Chaudhury P. Advances in hemodialysis therapy. Fac Rev. 2023;12:12. https://doi.org/10.12703/r/12-12

Zhang Z, Wang Y. Management of Cardiovascular Diseases in Chronic Hemodialysis Patients. Rev Cardiovasc Med. 2023 Jul;24(7):185. https://doi.org/10.31083/j.rcm2407185

Bansal N, Artinian NT, Bakris G, Chang T, Cohen J, Flythe J, et al. Hypertension in Patients Treated With In-Center Maintenance Hemodialysis: Current Evidence and Future Opportunities: A Scientific Statement From the American Heart Association. Hypertension. 2023 Jun 1;80(6):e112–22. https://doi.org/10.1161/HYP.0000000000000230

Yousaf MH, Abbas H, Shahzad F, Altaf A, Riaz S, Obaid M, et al. Prevalence and Patterns of Cardiac Arrhythmias in Patients With Chronic Kidney Disease Undergoing Hemodialysis: A Retrospective Study. Cureus. 2026 Jan;18(1):e100621. https://doi.org/10.7759/cureus.100621

Choi HY, Cho NJ, Park S, Lee H, Hong M, Lee EY, et al. Arrhythmia and Heart Rate Variability during Long Interdialytic Periods in Patients on Maintenance Hemodialysis: Prospective Observational Cohort Study. J Clin Med. 2022 Dec;12(1). https://doi.org/10.3390/jcm12010265

Kolben Y, Gork I, Peled D, Amitay S, Moshel P, Goldstein N, et al. Continuous Monitoring of Advanced Hemodynamic Parameters during Hemodialysis Demonstrated Early Variations in Patients Experiencing Intradialytic Hypotension. Biomedicines. 2024 May;12(6). https://doi.org/10.3390/biomedicines12061177

Veinot TC, Gillespie B, Argentina M, Bragg-Gresham J, Chatoth D, Collins Damron K, et al. Enhancing the Cardiovascular Safety of Hemodialysis Care Using Multimodal Provider Education and Patient Activation Interventions: Protocol for a Cluster Randomized Controlled Trial. JMIR Res Protoc. 2023 Apr;12:e46187. https://doi.org/10.2196/46187

Hecking M, Tu C, Zee J, Bieber B, Hödlmoser S, Reichel H, et al. Sex-Specific Differences in Mortality and Incident Dialysis in the Chronic Kidney Disease Outcomes and Practice Patterns Study. Kidney Int reports. 2022 Mar;7(3):410–23. https://doi.org/10.1016/j.ekir.2021.11.018

Shankar M, Satheesh G, A K, C G S, Reddy GG. Gender disparity in maintenance hemodialysis units in South India: a cross-sectional observational study. Front Nephrol. 2024;4:1322003. https://doi.org/10.3389/fneph.2024.1322003

Hu Y, Zhu X, Liu Y, Yang L, Sun Z, Zhang X, et al. Choosing dialysis modality in patients aged 75 and above with end-stage kidney disease: a multicenter cohort study. Sci Rep. 2025;16(1):2174.

Prasad B, Hemmett J, Suri R. Five Things to Know About Intradialytic Hypertension. Can J kidney Heal Dis. 2022;9:20543581221106656. https://doi.org/10.1038/s41598-025-31857-7

Okpa HO, Effa EE, Oparah SK, Chikezie JA, Bisong EM, Mbu PN, et al. Intradialysis blood pressure changes among chronic kidney disease patients on maintenance haemodialysis in a tertiary hospital south - south Nigeria: a 2 year retrospective study. Pan Afr Med J. 2019;33:91. https://doi.org/10.1177/20543581221106657

Lv J, Tian G, Chen J, Cong Y, Luo M, Lu X. Risk factors for the development of intradialytic hypotension in patients undergoing maintenance hemodialysis. Int Urol Nephrol. 2025 Dec;57(12):4325–32. https://doi.org/10.1007/s11255-025-04645-5

Alshahrani S. Renin-angiotensin-aldosterone pathway modulators in chronic kidney disease: A comparative review. Front Pharmacol. 2023;14:1101068. https://doi.org/10.3389/fphar.2023.1101068

Rogovoy NM, Howell SJ, Lee TL, Hamilton C, Perez-Alday EA, Kabir MM, et al. Hemodialysis Procedure-Associated Autonomic Imbalance and Cardiac Arrhythmias: Insights From Continuous 14-Day ECG Monitoring. J Am Heart Assoc. 2019 Oct;8(19):e013748. https://doi.org/10.1161/JAHA.119.013748

Lertdumrongluk P, Streja E, Rhee CM, Sim JJ, Gillen D, Kovesdy CP, et al. Changes in pulse pressure during hemodialysis treatment and survival in maintenance dialysis patients. Clin J Am Soc Nephrol. 2015 Jul;10(7):1179–91. https://doi.org/10.2215/CJN.09000914

Reeves PB, Mc Causland FR. Mechanisms, Clinical Implications, and Treatment of Intradialytic Hypotension. Clin J Am Soc Nephrol. 2018 Aug;13(8):1297–303. https://doi.org/10.2215/CJN.12141017

Ma K, Gao W, Xu H, Liang W, Ma G. Role and Mechanism of the Renin-Angiotensin-Aldosterone System in the Onset and Development of Cardiorenal Syndrome. J Renin Angiotensin Aldosterone Syst. 2022;2022:3239057. https://doi.org/10.1155/2022/3239057

Łagosz P, Biegus J, Urban S, Zymliński R. Renal Assessment in Acute Cardiorenal Syndrome. Biomolecules. 2023 Jan;13(2). https://doi.org/10.3390/biom13020239




DOI: https://doi.org/10.70111/hg4305

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