Risk factors for the development of intradialytic hypotension in patients undergoing maintenance hemodialysis

Intradialytic hypotension (IDH) is a common and serious complication in patients undergoing maintenance hemodialysis (MHD). This study aimed to investigate the risk factors for the development of IDH in MHD patients and explore the predictive value of dialysis parameters and body composition parameters measured using bioelectrical impedance analysis (BIA) to assess the occurrence of IDH.

This study included 201 outpatients who underwent MHD. Differences in clinical, laboratory, and BIA-related indexes between the IDH group and NO-IDH group were retrospectively analyzed, and the influencing factors of IDH in MHD patients were analyzed using multivariate logistic regression. A receiver operating characteristic (ROC) curve was constructed to predict the optimal critical value for the occurrence of IDH in MHD patients.

The percentage of IDH in the included patients was 42.79%. Univariate analysis showed that pre-dialysis systolic blood pressure, ultrafiltration volume, inter-dialysis weight gain (IDWG), inflammation score (MIS), high-sensitivity C-reactive protein, brain natriuretic peptide (BNP), phase angle (PA), overhydration (OH), extracellular water (ECW)/total body water (TBW), and ECW/ body cell mass (BCM) were associated with IDH. Ultrafiltration volume, IDWG, PA, and ECW/TBW were highly statistically significant in predicting IDH in multivariate logistic regression analysis. Based on the ROC results, it was shown that IDH could be assessed by combining dialysis parameters and correlates measured by BIA.

In conclusion, BIA-measured body composition may be used to guide the management of dialysis and out-of-hospital volumetric and nutritional status, maximize the effective circulating blood volume during dialysis, and guard against the occurrence of IDH.