Frequency of intradialytic hypotensive episodes: old problem, new insights

Symptomatic intradialytic hypotension (IDH) continues to be an important complication of hemodialysis treatment. There is some evidence that besides an IDH episode, repeated episodes could represent an even more important independent risk factor for mortality in hemodialysis patients. A retrospective cross-sectional study was performed to study 18 dialysis treatments in 43 patients during 6 weeks. Relationships of IDH episodes with baseline variables were examined using a Poisson regression model (generalized linear model). IDH was frequent (93% of patients) and highly variable by patient (0%-100%). Multivariate analysis showed that patients who experienced frequent hypotensive episodes had a lower dry weight (90% confidence interval [CI]: 0.95-0.99), higher phosphorus levels (90% CI: 1.07-1.47), greater prevalence of diabetes mellitus (90% CI: 1.11-2.71), and hypertension (90% CI: 1.04-2.45). Dry weight, hypertension, and phosphorus levels are modifiable risk factors to possibly reduce the rate of IDH episodes. The potential protective role of phosphorus warrants further investigation.