The Association Between the Time of Onset of Intradialytic Hypotension and Mortality in Incident Hemodialysis Patients

Hung-Chieh Wu ； Lu-Chien Lu ； Wei-Jie Wang ； Lin-Chien Lee

《Acta Nephrologica》 36卷2期 (2022/06) Pp. 77-89

https://doi.org/10.6221/AN.202206_36(2).0004

摘要

BACKGROUND: Intradialytic hypotension (IDH) was a risk factor for death. This study examined whether the time of IDH onset was associated with mortality. METHODS: Elderly men who initiated hemodialysis (HD) in Taoyuan General Hospital from March 2014 to June 2019 were enrolled. Body composition, echocardiography as well as frequency and time of IDH were assessed during the baseline period. We reviewed clinical characteristics and biochemical data and followed them over 3 years. We defined IDH as a drop of systolic blood pressure (SBP) ≥ 20 mmHg or mean arterial pressure ≥ 10 mmHg that needed intervention. We stratified subjects according to the frequency and time of IDH. Adjusted odds ratios (aORs) were used to assess risk factors of IDH, whereas adjusted hazard ratios (aHRs) were evaluated for death and cumulative survival curves using Cox hazards model and Kaplan Meier method. RESULTS: From a total of 317 subjects on HD, the prevalence of prone to early- and late-onset IDH were 10.4% and 6.6%. Ultrafiltration rate, interdialytic weight gain, diabetes, and left ventricular hypertrophy were predictors for early-onset IDH (aORs were 1.782, 2.913, 3.323, and 4.208). After multivariate adjustment, prone to early-onset IDH was a significant predictor for 3-year cardiovascular death (aHR [95% confidence interval]: 3.28 [1.03-7.01]). CONCLUSIONS: Prone to early-onset IDH was a predictor of short-term survival in HD subjects. It might provide more survival information than late-onset IDH did.

關鍵字

mortality ； hemodialysis ； body composition ； intradialytic hypotension ； echocardiography