Intradialytic hypotension is associated with dialytic age in patients on chronic hemodialysis

Abstract

Objective: Intradialytic hypotension (IDH) is common in patients on chronic hemodialysis, but knowledge on determinants is still unclear. The present study aims at evaluating the association between IDH and dialytic age (DA) in patients on chronic hemodialysis. Methods: Between January 2012 and January 2013, 82 patients on chronic hemodialysis for at least 1 year were screened for inclusion in the present study. Of these, 14 were excluded because of advanced heart failure (n.9), history of alcohol/substance abuse (n.1), diagnosis of dementia (n.2), actual instability of clinical conditions requiring hospitalization (n.2). IDH was defined as a decrease in systolic blood pressure !20 mmHg or a decrease in mean arterial pressure (MAP) by 10 mmHg associated with clinical events and need for nursing interventions. The number of IDH episodes in 10 consecutive hemodialysis sessions was recorded for each patient. Linear and logistic regressions were adopted to assess the adjusted association between IDH and DA. Conclusion: DA is associated with an increased probability of IDH and with increased number of IHD events. Studies are needed to understand the underlying factors of such an association.

Prevalence of intradialytic hypotension, clinical symptoms and nursing interventions - a three-months, prospective study of 3818 haemodialysis sessions

“…To the best of our knowledge, there are only 2 other studies that investigated the prevalence of dialysis hypotension as defined according to the definition in the EBPG guideline on haemodynamic stability. The prevalence of dialysis hypotension according to this definition in these studies was 5.0 % [ 25 ] and 11.2 % [ 24 ].…”

“…These vary from liberal definitions that only require a minimum fall (e.g. ≥20 or ≥30 mmHg) in systolic blood pressure (SBP) [ 19 – 21 ] to strict definitions that require the combination of a clinical event and a nursing intervention in addition to a minimum fall in blood pressure [ 22 – 24 ]. The European Best Practice Guideline (EBPG) on haemodynamic instability defines IDH as a decrease in SBP ≥20 mmHg or a decrease in mean arterial pressure (MAP) by ≥10 mmHg associated with a clinical event and the need for a nursing intervention [ 22 ].…”

“…The European Best Practice Guideline (EBPG) on haemodynamic instability defines IDH as a decrease in SBP ≥20 mmHg or a decrease in mean arterial pressure (MAP) by ≥10 mmHg associated with a clinical event and the need for a nursing intervention [ 22 ]. To the best of our knowledge, there are only two small studies that investigated the prevalence of IDH according to the EBPG definition [ 24 , 25 ].…”

The Prevalence of Intradialytic Hypotension in Patients on Conventional Hemodialysis: A Systematic Review with Meta-Analysis

“…The most commonly reported patient-related factors were the presence of diabetes [9,18,22,23,28,29,35,36] and a higher IDWG [19,20,25,29,33,35,36]. Both factors together were mentioned in 3 studies [29,35,36].…”

“…Two studies excluded patients because of incomplete or unavailable BP data [21,32], and 1 study specified that patients with acute renal failure were not included [30]. Three studies excluded patients with comorbidities [5,28,33] or diabetes [34] (online suppl. File 2).…”