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Published on: October 2, 2020
Intradialytic hypotension is an important risk factor for critical limb ischemia in patients on hemodialysis
Ryo Matsuura1,2, Sumi Hidaka3, Takayasu Ohtake1
1Kidney Disease and Transplant Center, Shonan Kamakura General Hospital, 1370-1, Okamoto, Kamakura, 247-8533, Japan.
Insights
Intradialytic hypotension (IDH) is a significant risk factor for critical limb ischemia (CLI) in patients undergoing hemodialysis (HD). This study found IDH independently predicts new-onset CLI or related death in HD patients.
Area of Science:
- Nephrology
- Vascular Surgery
- Cardiology
Background:
- Critical limb ischemia (CLI) and intradialytic hypotension (IDH) are prevalent complications in hemodialysis (HD) patients.
- Limited research exists on the association between IDH and CLI in this vulnerable population.
Purpose of the Study:
- To investigate whether intradialytic hypotension (IDH) serves as an independent risk factor for developing critical limb ischemia (CLI) in patients undergoing hemodialysis (HD).
Main Methods:
- A retrospective study analyzed 147 HD patients, defining IDH by a ≥20 mmHg systolic blood pressure drop and nadir <90 mmHg.
- Outcomes assessed included new CLI requiring revascularization or CLI-related death over a median 24.5-month follow-up.
- Multivariable subdistribution hazard models adjusted for cardiovascular risk factors.
Main Results:
- 34% of patients experienced IDH episodes.
- IDH was significantly associated with incident CLI (subdistribution hazard ratio: 3.13; 95% CI, 1.05-9.37).
- Factors like age, smoking, diabetes, peripheral arterial disease, and cardiovascular disease history were also linked to CLI.
Conclusions:
- Intradialytic hypotension (IDH) is identified as an independent risk factor for critical limb ischemia (CLI) in patients on hemodialysis (HD).
- These findings highlight the importance of monitoring and managing IDH to potentially prevent CLI progression in HD patients.
Background:
Critical limb ischemia (CLI) and intradialytic hypotension (IDH) are common complications in patients on hemodialysis (HD). However, limited data are available on whether IDH is related to CLI in these patients. The aim of this retrospective study was to evaluate whether IDH is a risk factor for CLI in HD patients.
Methods:
We examined the frequency of IDH in 147 patients who received HD between January 1 and June 30, 2012. Blood pressure was measured during HD every 30 min and IDH was defined as a ≥ 20 mmHg fall in systolic blood pressure compared to 30 min before and a nadir intradialytic systolic blood pressure < 90 mmHg. The primary study outcome was newly developed CLI requiring revascularization treatment or CLI-related death. We assessed the association of IDH with outcome using a multivariable subdistribution hazard model with adjustment for male, age, smoking and history of cardiovascular disease.
Results:
The median follow-up period was 24.5 months. Fifty patients (34%) had episodes of IDH in the study entry period. During follow-up, 14 patients received endovascular treatment and CLI-related death occurred in 1 patient. Factors associated with incident CLI in univariate analysis were age, smoking, diabetes mellitus, peripheral arterial disease, history of cardiovascular disease, and IDH. IDH was significantly associated with the outcome with the subdistribution hazard ratio of 3.13 [95% confidence interval, 1.05-9.37].
Conclusions:
IDH was an independent risk factor for incident CLI in patients on HD.
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