{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,10]],"date-time":"2026-11-10T20:59:02Z","timestamp":1794344342055,"version":"4.9.0"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T00:00:00Z","timestamp":1762819200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"name":"Niercentrum aan de Amstel"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Intradialytic hypotension (IDH) has been associated with both morbidity and mortality. Yet, as IDH often occurs asymptomatic, it might be easily missed with routine twice per hour brachial artery cuff-blood pressure (BAC-BP) readings. This study evaluated differences in IDH detection between intermittent BAC-BP and continuous BP monitoring with a finger cuff (FC-BP). Validation of the FC device was an additional objective.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>In 40 chronic dialysis patients, intradialytic BP was measured during four sessions using (i) BAC-BP every 15 minutes and (ii) beat-to-beat FC-BP readings, which were averaged over 20-seconds intervals. IDH was defined as a systolic BP (SBP) &amp;lt;90 or &amp;lt;100 mmHg, depending on pre-dialysis SBP. Only FC measurements with an acceptable accuracy (i.e. mean SBP bias \u226410\u00a0mmHg) were used for the IDH analysis. For validation, sequential same-arm BP measurements were compared, using Bland\u2013Altman analyses to assess agreement and four-quadrant plots to evaluate concordance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>For IDH analysis, 144 BAC-BP readings and 18\u2009163 FC-BP measurements were recorded in 106 hours. While BAC-BP identified 20 IDH episodes, 441 were detected by FC-BP. For validation, Bland\u2013Altman analyses of 1221 paired BP readings showed a mean bias\u00a0\u00b1\u00a0limits of agreement of \u221213.3\u00a0\u00b1\u00a044.5 mmHg for SBP and \u221213.3\u00a0\u00b1\u00a025.5 mmHg for diastolic BP. Only 27.7% of the paired FC-BP readings met the acceptable accuracy criterion. Concordance rates were 34.3% and 36.3%, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>First, the occurrence of IDH is severely underestimated with intermittent BP monitoring. Second, FC-BP appears unsuitable for routine intradialytic BP monitoring due to its poor accuracy, precision, and concordance.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/ckj\/sfaf337","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T12:54:29Z","timestamp":1762865669000},"source":"Crossref","is-referenced-by-count":1,"title":["Intradialytic hypotension is severely underreported by intermittent blood pressure readings"],"prefix":"10.1093","volume":"19","author":[{"given":"Sabrine","family":"Chaara","sequence":"first","affiliation":[{"name":"Amsterdam University Medical Centre Department of Internal Medicine, division of Nephrology, , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam University Medical Centre Amsterdam Cardiovascular Sciences, Diabetes & Hypertensive Diseases, , Amsterdam,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muriel P C","family":"Grooteman","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Centre Department of Internal Medicine, division of Nephrology, , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam University Medical Centre Amsterdam Cardiovascular Sciences, Diabetes & Hypertensive Diseases, , Amsterdam,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Menso J","family":"Nub\u00e9","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Centre Department of Internal Medicine, division of Nephrology, , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam University Medical Centre Amsterdam Cardiovascular Sciences, Diabetes & Hypertensive Diseases, , Amsterdam,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willem Jan W","family":"Bos","sequence":"additional","affiliation":[{"name":"St. Antonius Hospital Department of Internal Medicine, , Nieuwegein ,","place":["the Netherlands"]},{"name":"Leiden University Medical Centre Department of Internal Medicine, , Leiden ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul A","family":"Rootjes","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Centre Department of Internal Medicine, division of Nephrology, , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam University Medical Centre Amsterdam Cardiovascular Sciences, Diabetes & Hypertensive Diseases, , Amsterdam,","place":["the Netherlands"]},{"name":"Gelre Hospitals Department of Internal Medicine, , Apeldoorn ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gertrude","family":"Wijngaarden","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Centre Department of Internal Medicine, division of Nephrology, , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam University Medical Centre Amsterdam Cardiovascular Sciences, Diabetes & Hypertensive Diseases, , Amsterdam,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6369-8341","authenticated-orcid":false,"given":"Camiel L M","family":"de Roij van Zuijdewijn","sequence":"additional","affiliation":[{"name":"Amsterdam University Medical Centre Department of Internal Medicine, division of Nephrology, , Amsterdam ,","place":["the Netherlands"]},{"name":"Amsterdam University Medical Centre Amsterdam Cardiovascular Sciences, Diabetes & Hypertensive Diseases, , Amsterdam,","place":["the Netherlands"]},{"name":"Spaarne Gasthuis Department of Internal Medicine, , Haarlem ,","place":["the Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,11,11]]},"reference":[{"key":"2026010909365018000_bib1","doi-asserted-by":"publisher","first-page":"2124","DOI":"10.2215\/CJN.02680314","article-title":"Intradialytic hypotension and risk of cardiovascular disease","volume":"9","author":"Stef\u00e1nsson","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026010909365018000_bib2","doi-asserted-by":"publisher","first-page":"724","DOI":"10.1681\/ASN.2014020222","article-title":"Association of mortality risk with various definitions of intradialytic hypotension","volume":"26","author":"Flythe","year":"2015","journal-title":"J Am Soc Nephrol"},{"key":"2026010909365018000_bib3","doi-asserted-by":"publisher","first-page":"1212","DOI":"10.1111\/j.1523-1755.2004.00812.x","article-title":"Hemodialysis-associated hypotension as an independent risk factor for two-year mortality in hemodialysis patients","volume":"66","author":"Shoji","year":"2004","journal-title":"Kidney Int"},{"key":"2026010909365018000_bib4","doi-asserted-by":"publisher","first-page":"158","DOI":"10.1159\/000503776","article-title":"Intradialytic hypotension: mechanisms and outcome","volume":"49","author":"Sars","year":"2020","journal-title":"Blood Purif"},{"key":"2026010909365018000_bib5","doi-asserted-by":"publisher","first-page":"981","DOI":"10.1093\/ckj\/sfaa078","article-title":"An update review of intradialytic hypotension: concept, risk factors, clinical implications and management","volume":"13","author":"Kanbay","year":"2020","journal-title":"Clin Kidney J"},{"key":"2026010909365018000_bib6","doi-asserted-by":"publisher","first-page":"209","DOI":"10.1186\/s12882-023-03263-6","article-title":"Impact of frequent intradialytic hypotension on quality of life in patients undergoing hemodialysis","volume":"24","author":"Wang","year":"2023","journal-title":"BMC Nephrol"},{"key":"2026010909365018000_bib7","doi-asserted-by":"publisher","first-page":"914","DOI":"10.2215\/CJN.03900808","article-title":"Hemodialysis-induced cardiac injury: determinants and associated outcomes","volume":"4","author":"Burton","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026010909365018000_bib8","doi-asserted-by":"publisher","first-page":"1925","DOI":"10.2215\/CJN.04470709","article-title":"Hemodialysis-induced repetitive myocardial injury results in global and segmental reduction in systolic cardiac function","volume":"4","author":"Burton","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"2026010909365018000_bib9","doi-asserted-by":"publisher","first-page":"2511","DOI":"10.1681\/ASN.2016060704","article-title":"Relationship between hypotension and cerebral ischemia during hemodialysis","volume":"28","author":"MacEwen","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"2026010909365018000_bib10","doi-asserted-by":"publisher","first-page":"c23","DOI":"10.1159\/000077592","article-title":"Dialysis-related hypotension as a cause of progressive frontal lobe atrophy in chronic hemodialysis patients: a 3-year prospective study","volume":"97","author":"Mizumasa","year":"2004","journal-title":"Nephron Clin Pract"},{"key":"2026010909365018000_bib11","doi-asserted-by":"publisher","first-page":"603","DOI":"10.1016\/j.ekir.2019.01.001","article-title":"Cumulative exposure to frequent intradialytic hypotension associates with new-onset dementia among elderly hemodialysis patients","volume":"4","author":"Assimon","year":"2019","journal-title":"Kidney Int Rep"},{"key":"2026010909365018000_bib12","doi-asserted-by":"publisher","first-page":"1046","DOI":"10.1046\/j.1523-1755.2002.00505.x","article-title":"Predictors of the rate of decline of residual renal function in incident dialysis patients","volume":"62","author":"Jansen","year":"2002","journal-title":"Kidney Int"},{"key":"2026010909365018000_bib13","doi-asserted-by":"publisher","first-page":"84","DOI":"10.1016\/S1072-7515(99)00226-4","article-title":"Nonocclusive mesenteric infarction in hemodialysis patients","volume":"190","author":"John","year":"2000","journal-title":"J Am Coll Surg"},{"key":"2026010909365018000_bib14","doi-asserted-by":"publisher","first-page":"521","DOI":"10.1093\/ndt\/6.7.521","article-title":"Ischaemic hepatic necrosis and intestinal infarction in a haemodialysis patient","volume":"6","author":"Ortiz","year":"1991","journal-title":"Nephrol Dial Transplant"},{"key":"2026010909365018000_bib15","doi-asserted-by":"publisher","first-page":"1517","DOI":"10.2215\/CJN.13891217","article-title":"The relationship between intradialytic hypotension and hospitalized mesenteric ischemia: a case-control study","volume":"13","author":"Seong","year":"2018","journal-title":"Clin"},{"key":"2026010909365018000_bib16","doi-asserted-by":"publisher","first-page":"c87","DOI":"10.1159\/000086346","article-title":"Non-occlusive mesenteric ischemia in chronically dialyzed patients: a disease with multiple risk factors","volume":"101","author":"Ori","year":"2005","journal-title":"Nephron Clin Pract"},{"key":"2026010909365018000_bib17","doi-asserted-by":"publisher","first-page":"545","DOI":"10.1097\/MNH.0000000000000271","article-title":"Intradialytic hypotension","volume":"25","author":"Gul","year":"2016","journal-title":"Curr Opin Nephrol Hypertens"},{"key":"2026010909365018000_bib18","doi-asserted-by":"publisher","first-page":"497","DOI":"10.1159\/000500877","article-title":"The prevalence of intradialytic hypotension in patients on conventional hemodialysis: a systematic review with meta-analysis","volume":"49","author":"Kuipers","year":"2019","journal-title":"Am J Nephrol"},{"key":"2026010909365018000_bib19","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfae069.760","article-title":"#672 Intradialytic hypotension and adverse symptoms are not related","volume":"39","author":"Chaara","year":"2024","journal-title":"Nephrol Dial Transplant"},{"key":"2026010909365018000_bib20","doi-asserted-by":"publisher","first-page":"25","DOI":"10.1016\/j.bja.2020.03.013","article-title":"Continuous noninvasive pulse wave analysis using finger cuff technologies for arterial blood pressure and cardiac output monitoring in perioperative and intensive care medicine: a systematic review and meta-analysis","volume":"125","author":"Saugel","year":"2020","journal-title":"Br J Anaesth"},{"key":"2026010909365018000_bib21","doi-asserted-by":"publisher","first-page":"609","DOI":"10.1093\/bja\/aes295","article-title":"Level of agreement between Nexfin non-invasive arterial pressure with invasive arterial pressure measurements in children","volume":"109","author":"Garnier","year":"2012","journal-title":"Br J Anaesth"},{"key":"2026010909365018000_bib22","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1080\/10641950802601260","article-title":"Continuous non-invasive blood pressure monitoring, a validation study of Nexfin in a pregnant population","volume":"28","author":"Akkermans","year":"2009","journal-title":"Hypertens Pregnancy"},{"key":"2026010909365018000_bib23","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1186\/s12882-021-02331-z","article-title":"Effect of various dialysis modalities on intradialytic hemodynamics, tissue injury and patient discomfort in chronic dialysis patients: design of a randomized cross-over study (HOLLANT)","volume":"22","author":"Rootjes","year":"2021","journal-title":"BMC Nephrol"},{"key":"2026010909365018000_bib24","first-page":"S1","article-title":"K\/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients","volume":"45","year":"2005","journal-title":"Am J Kidney Dis"},{"key":"2026010909365018000_bib25","article-title":"Nederlandse Federatie voor Nefrologie","author":"Richtlijnen","year":"2023"},{"key":"2026010909365018000_bib26","first-page":"1030","article-title":"[Contribution to the continuous indirect blood pressure measurement]","volume":"31","author":"Pen\u00e1z","year":"1976","journal-title":"Z Gesamte Inn Med"},{"key":"2026010909365018000_bib27","doi-asserted-by":"publisher","first-page":"472","DOI":"10.1097\/HJH.0000000000001634","article-title":"A universal standard for the validation of blood pressure measuring devices: Association for the Advancement of Medical Instrumentation\/European Society of Hypertension\/International Organization for Standardization (AAMI\/ESH\/ISO) Collaboration Statement","volume":"36","author":"Stergiou","year":"2018","journal-title":"J Hypertens"},{"key":"2026010909365018000_bib28","doi-asserted-by":"publisher","first-page":"1180","DOI":"10.1213\/ANE.0b013e3181f08a5b","article-title":"A critical review of the ability of continuous cardiac output monitors to measure trends in cardiac output","volume":"111","author":"Critchley","year":"2010","journal-title":"Anesthesia Analgesia"},{"key":"2026010909365018000_bib29","doi-asserted-by":"publisher","first-page":"1980","DOI":"10.1016\/j.ekir.2022.06.021","article-title":"High-volume hemodiafiltration and cool hemodialysis have a beneficial effect on intradialytic hemodynamics: a randomized cross-over trial of four intermittent dialysis strategies","volume":"7","author":"Rootjes","year":"2022","journal-title":"Kidney Int Rep"},{"key":"2026010909365018000_bib30","doi-asserted-by":"publisher","first-page":"149","DOI":"10.1093\/ndt\/gfx037","article-title":"Intradialytic hypotension, blood pressure changes and mortality risk in incident hemodialysis patients","volume":"33","author":"Chou","year":"2018","journal-title":"Nephrol Dial Transplant"},{"key":"2026010909365018000_bib31","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1093\/ajh\/5.8.529","article-title":"The reliability of noninvasive continuous finger blood pressure measurement in patients with both hypertension and vascular disease","volume":"5","author":"Bos","year":"1992","journal-title":"Am J Hypertens"},{"key":"2026010909365018000_bib32","doi-asserted-by":"publisher","first-page":"309","DOI":"10.1159\/000457812","article-title":"Noninvasive blood pressure measurement in maintenance hemodialysis patients: comparison of agreement between oscillometric and finger-cuff methods","volume":"136","author":"Alfano","year":"2017","journal-title":"Nephron"},{"key":"2026010909365018000_bib33","doi-asserted-by":"publisher","first-page":"2470","DOI":"10.1053\/j.jvca.2023.08.004","article-title":"Continuous noninvasive blood pressure measurement with \u201cclearsight\u201d compared to standard intermittent blood pressure measurement in patients with peripheral arterial disease. are potential differences influenced by phenylephrine or dobutamine?","volume":"37","author":"Wolfskeil","year":"2023","journal-title":"J Cardiothorac Vasc Anesth"},{"key":"2026010909365018000_bib34","doi-asserted-by":"publisher","first-page":"819","DOI":"10.1016\/S0272-6386(00)70250-2","article-title":"Cardiac and hemodynamic effects of hemodialysis and ultrafiltration","volume":"35","author":"Bos","year":"2000","journal-title":"Am J Kidney Dis"}],"container-title":["Clinical Kidney Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/ckj\/advance-article-pdf\/doi\/10.1093\/ckj\/sfaf337\/65269428\/sfaf337.pdf","content-type":"application\/pdf","content-version":"am","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/19\/1\/sfaf337\/65269428\/sfaf337.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/ckj\/article-pdf\/19\/1\/sfaf337\/65269428\/sfaf337.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T14:36:58Z","timestamp":1767969418000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/ckj\/article\/doi\/10.1093\/ckj\/sfaf337\/8320536"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,11]]},"references-count":34,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.1093\/ckj\/sfaf337","relation":{},"ISSN":["2048-8505","2048-8513"],"issn-type":[{"value":"2048-8505","type":"print"},{"value":"2048-8513","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,1]]},"published":{"date-parts":[[2025,11,11]]},"article-number":"sfaf337"}}