Risk of Intradialytic Hypotension by Day of the Week in Maintenance Hemodialysis

Abstract

Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD) and is associated with a higher risk of cardiovascular (CV) events and mortality. CV events are more common on the days of HD, especially following the longer interdialytic interval. We investigated the risk of IDH according to day of HD in adults undergoing in-center, thrice-weekly HD in the Hemodialysis (HEMO) Study (N = 1,837 patients; n = 64,474 sessions), and the DaVita Clinical Research biorepository [BioReG]) (N = 952 patients; n = 61,197 sessions). Random effects logistic regression models assessed the risk of IDH (defined as nadir intra-HD systolic blood pressure [SBP] <90 mm Hg if pre-HD SBP <160 mm Hg, or <100 mm Hg if pre-HD SBP ≥160 mm Hg [Nadir90/100 definition]) according to HD day (Mon/Tue [HD1]; Wed/Thu [HD2]; Fri/Sat [HD3]). Alternative definitions of IDH were explored. Nadir90/100 occurred in 14% of HEMO and 18% of BioReG sessions. A monotonic increase in the risk of IDH was observed for HD2 and HD3, compared with HD1, for all IDH definitions in both cohorts. Compared with HD1, HD2 was associated with a 10% higher risk of Nadir90/100 (adjusted odds ratio, 1.10; 95% CI, 1.03–1.17) and HD3 was associated with a 31% higher risk (adjusted odds ratio, 1.31; 95% CI, 1.19–1.45) in HEMO, with consistent results in BioReG. We observed a monotonic increased risk of IDH with later days of the dialytic week in two separate cohorts. Further research to determine the underlying mechanisms is necessary to guide strategies for IDH prevention.

Correlation between geriatric nutritional risk index and intradialytic hypotension in elderly patients undergoing maintenance hemodialysis: a case-control study

“…In addition, independent risk factors for IDH include dietary intake, duration of dialysis, iPTH levels, interdialytic weight gain, administration of antihypertensive drugs before dialysis, mean corpuscular volume, albumin level, and systolic blood pressure pre-dialysis. These findings are consistent with previous studies [3,17]. However, the International Society for Renal Nutrition and Metabolism has reached a consensus stating that the provision of nutrition during the process of hemodialysis can enhance the individual's nutritional status, and ultimately contribute to improved survival rates [26].…”

“…Maintenance hemodialysis (MHD) is the primary renal replacement therapy modality for ESRD in most countries [2]. However, intradialytic hypotension (IDH) poses a significant and prevalent complication in the context of MHD, with reported incidence rates ranging from 20-30% [3]. In addition, the etiology of IDH is not fully understood, but may involve transient intravascular hypovolemia, impaired compensatory mechanisms, and end-organ hypoperfusion, leading to a higher risk of cardiovascular events and mortality [4,5].…”

To Cool the Dialysate or Not? Question Answered?

“…Of note, some reports have suggested that the frequency of intradialytic hypotension is higher as the dialysis week progresses, so the lack of sampling from earlier weekdays seems less likely to have missed hypotensive events. 10 However, the proportion of patients who opted out at each center was not reported, and all patients at a given center were eligible for data sampling (even those who opted out of the intervention). Considered in addition to the nonadherence rate of 20% and crossover of some patients, the sampling of approximately 1% of the dialysis sessions introduces the potential for bias in the data collected and the possibility that an effect of the intervention on BP was missed.…”