RISK FACTORS ASSOCIATED WITH INTRADIALYTIC HYPOTENSION: A RETROSPECTIVE CROSS-SECTIONAL ANALYTICAL STUDY
Keywords:
Intradialytic hypotension, risk factors, hemodialysis, retrospective analytical studyAbstract
Background: Intradialytic hypotension (IDH) is the most common complication during hemodialysis, with a reported incidence of 10–30%. IDH is associated with increased mortality and various complications. Although risk factors for IDH have been extensively studied in other countries, comprehensive data in Thai dialysis populations are limited. Differences in clinical characteristics, comorbidities, and risk profiles between Thai patients and those in high-income settings may exist; identifying local risk factors is therefore important to develop effective prevention strategies.
Materials and methods: We performed a retrospective analytic study by reviewing medical records of patients with acute and chronic kidney failure who underwent hemodialysis at Srinagarind Hospital, Khon Kaen University, between January and December 2022. Data sources included the electronic medical record and hemodialysis treatment records. Clinical variables potentially associated with intradialytic hypotension were extracted. Statistical analysis used logistic regression and multivariable logistic regression to identify factors independently associated with IDH. Analyses were performed with STATA version 17.
Results: A total of 349 patients underwent 1,500 hemodialysis sessions. IDH occurred in 29.06% of sessions. Factors independently associated with IDH (p < 0.05) included cirrhosis (adjusted odds ratio [aOR] 3.01; 95% confidence interval [CI] 1.52–5.59), pre-dialysis systolic blood pressure <110 mmHg (aOR 2.89; 95% CI 1.40–5.94), serum potassium <3.4 mEq/L (aOR 2.75; 95% CI 1.49–5.07), use of mechanical ventilation (aOR 2.07; 95% CI 1.49–2.86), malignancy (aOR 1.78; 95% CI 1.06–2.96), oxygen saturation <95% (aOR 1.55; 95% CI 1.16–2.07), serum albumin <3 g/dL (aOR 1.44; 95% CI 1.04–1.98), heart disease with arrhythmia (aOR 1.42; 95% CI 1.06–2.96), ultrafiltration rate >13 mL/kg/hr (aOR 1.21; 95% CI 1.06–1.39), and age >65 years (aOR 1.02; 95% CI 1.01–1.03).
Conclusions: Older age, multiple comorbidities-particularly cirrhosis, malignancy, and cardiac disease with arrhythmia-low pre-dialysis blood pressure, poor nutritional status, electrolyte imbalances, low oxygen saturation, requirement for mechanical ventilation, and high ultrafiltration rates are independently associated with intradialytic hypotension. Patients with these risk factors should receive appropriate monitoring and preventive measures to guide targeted strategies for the management and prevention of IDH in hemodialysis populations.
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