Related Experiment Video
Updated: Nov 15, 2025
Measurement of Tissue Oxygenation Using Near-Infrared Spectroscopy in Patients Undergoing Hemodialysis
Published on: October 2, 2020
Serum Phosphorus Levels are Associated with Intradialytic Hypotension in Hemodialysis Patients
Kyung Hoon Yang1, Seong Cho1, Sung Rok Kim1
1Division of Nephrology, Department of Medicine, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Republic of Korea.
Insights
Higher serum phosphorus levels significantly increase the risk of intradialytic hypotension (IDH) in hemodialysis patients. This finding highlights the importance of managing phosphorus for patient safety during dialysis.
Area of Science:
- Nephrology
- Cardiovascular Medicine
- Clinical Nutrition
Background:
- Intradialytic hypotension (IDH) is a frequent and severe complication for hemodialysis (HD) patients.
- Hyperphosphatemia is prevalent in HD patients and linked to vascular calcification.
- Vascular calcification is associated with IDH, prompting investigation into phosphorus's role.
Purpose of the Study:
- To examine the association between serum phosphorus levels and the occurrence of IDH in hemodialysis patients.
- To determine if elevated phosphorus is an independent risk factor for IDH.
Main Methods:
- 173 patients undergoing HD for at least 3 months were enrolled.
- IDH was defined by specific hypotension criteria and symptoms.
- Serum phosphorus was analyzed as both a continuous and categorical variable.
Main Results:
- IDH occurred in 23.1% of patients.
- Each 1 mg/dL increase in serum phosphorus raised IDH odds by 2.1 times (OR: 2.11).
- The highest phosphorus tertile showed a 6.5-fold increased odds of IDH compared to the middle tertile (OR: 6.53).
Conclusions:
- Elevated serum phosphorus levels are significantly associated with a higher incidence of IDH in hemodialysis patients.
- Phosphorus management may be crucial in preventing IDH and improving patient outcomes.
Background:
Intradialytic hypotension (IDH) is a common serious complication in hemodialysis (HD) patients. Hyperphosphatemia is also common in HD patients and promotes vascular calcification. Given the association between vascular calcification and IDH, we investigated the association between IDH and serum phosphorus in HD patients.
Methods:
We enrolled 173 patients who received HD for 3 months or more. IDH was defined as a nadir systolic blood pressure (SBP) <90 mm Hg or as a decrease in SBP ≥20 mm Hg or a decrease in mean arterial pressure by 10 mm Hg with the occurrence of hypotension-related symptoms requiring intervention. Serum phosphorus levels were analyzed both as a continuous variable and as a categorical variable.
Results:
IDH occurred in 40 (23.1%) of the 173 patients. The mean phosphorus level was 4.9 mg/dL. A 1 mg/dL higher serum phosphorus resulted in a 2.1-fold greater odds of IDH. The fully adjusted odds ratio (OR) and 95% confidence interval (CI) were 2.11 (1.48-3.01). High categorized phosphorus levels were also associated with IDH. The highest tertile of serum phosphorus was associated with 6.5-fold greater odds of developing IDH compared to the referent group (the middle tertile of serum phosphorus, 4.0-<5.3 mg/dL); the fully adjusted OR (95% CIs) were 6.53 (2.23-19.09). In subgroup analyses, diabetes and pre-dialysis SBP modified the association between IDH and phosphorus levels, with a more pronounced association in diabetic patients and pre-dialysis SBP ≥140 mm Hg.
Conclusion:
In HD patients, higher phosphorus levels were associated with an increased occurrence of IDH.
Related Concept Videos
01:28Chronic Kidney Disease III: Interprofessional Care
01:25Peritoneal Dialysis III: Nursing Management
01:25Hemodialysis III: Nursing Management
01:24Hemodialysis II: Procedure and Complications
01:24Serum Studies: Renal Function Tests
01:24Chronic Kidney Disease II: Clinical Manifestations