Factors associated with the presence of resistant arterial hypertension in patients with stage 5 chronic kidney disease undergoing renal replacement therapy treated at a high-complexity health institution in the city of Pereira in the year 2022–2023

Abstract

Introduction: Resistant arterial hypertension (RAH) is described as a significant risk factor for the development of chronic kidney disease (CKD). Currently, it is defined as blood pressure that remains at or above 140/90 mm Hg and is uncontrolled despite the use of three classes of antihypertensive drugs at their maximum tolerated doses.
Objective: To identify the risk factors associated with the presence of RAH in patients with stage 5 CKD undergoing replacement therapy, treated at a high-complexity healthcare institution in the city of Pereira during the period 2022–2023.
Methodology: A cross-sectional descriptive study with an analytical intent was conducted, including a total of 255 patients with stage 5 CKD receiving care at a renal unit and undergoing hemodialysis in the city of Pereira. Data were collected through medical records, identifying patients who met the inclusion criteria. Data analysis was performed using SPSS software, generating frequency distribution tables, variable cross-tabulations, chi-square tests, odds ratios (OR), and bivariate and multivariate logistic regression analysis.

Results: The prevalence of RAH was 44%. The most frequent etiology of CKD was arterial hypertension. Among sociodemographic variables, 61.7% of patients were male, 87.5% were from Pereira, and the average age was 61 years (range: 24–89 years). Additionally, 58.2% were single, 78.1% were enrolled in the subsidized healthcare system, and 80.1% had completed only primary education. Regarding clinical variables, 59.6% had diabetes, 44.1% presented with RAH, 82.7% were at high cardiovascular risk, 54.7% had cardiovascular disease, and 1.7% had cerebrovascular disease; 38.3% were overweight, and 73.0% were non-adherent to treatment. Statistically significant associations (p ≤ 0.005) were found in variables such as age, use of two classes of antihypertensives, and use of three pharmacological groups. Relationships between variables were determined through bivariate analysis and risk estimation (OR). Multivariate analysis was used to describe the probability of associations between crossed variables.
Conclusions: In the studied population of stage 5 CKD patients undergoing hemodialysis during the 2022–2023 period, the prevalence of RAH was 44%. The use of two classes of antihypertensive drugs was considered a protective factor against this condition, whereas the use of three antihypertensive drugs was identified as a risk factor for the development of RAH.