Clinical factors associated with intradialytic hypotension.

A single-center study.

Abstract

Introduction: Intradialytic hypotension (IDH) is a frequent complication during hemodialysis sessions and increases the risk of thrombosis of arteriovenous fistulas, myocardial stunning, and death, among others. The objective of the present study was to identify the risk factors associated with IDH in an observational study of a cohort of Mexican subjects on hemodialysis.

Methods: From September to November 2013, 1344 intermittent hemodialysis sessions were evaluated and attended in a single center. IDH was defined as a decrease in systolic blood pressure ≥20 mmHg or a decrease in mean arterial pressure ≥10 mmHg accompanied by clinical symptoms or the need to reduce or suspend the ultra-filtrate (UF) during the session. Among other clinical variables, exposure to the hourly UF rate and the appearance or absence of IDH were recorded.

Results: 112 patients were included, with a median age of 57 years (interquartile range [IQR] 42-67); 66 cases (59%) were women. The frequency of IDH events was 5.4% (73 events); 76 subjects (68%) did not have any hypotensive events, and nine subjects (8%) had more than 2 IDH events. In the group with IDH, the pulse pressure was 77 versus 65 mmHg. In the group without IDH, the UF/hour/weight rate was 13.3 versus 10.9 ml/kg/hr, respectively (P<0.001). In the multivariate analysis, age (Odds Ratio [OR]=1.029), ultrafiltrate volume (OR=1.005), and pre-hemodialysis pulse pressure (OR=1.029) were independently associated with IDH (P<0.001).

Conclusions: The factors associated with IDH were older age, higher ultrafiltration rates, and higher pre-hemodialysis pulse pressure.