Intradialytic Hypotensive Episodes are Only Occasionally Associated With Adverse Symptoms

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Patient-Reported Outcomes

Background:

• Intradialytic hypotension (IDH) is a frequent complication of hemodialysis (HD), yet lacks a consensus definition.
• Existing guidelines often require symptoms or interventions, but threshold-based blood pressure (BP) definitions show stronger mortality associations.
• This study investigates IDH in HD and hemodiafiltration (HDF) patients, focusing on real-time symptoms and patient-reported outcomes.

Purpose of the Study:

• To evaluate the association between intradialytic hypotension (IDH) and both real-time symptoms and physical intradialytic patient-reported outcome measures (PID-PROMs).
• To assess the incidence of symptomatic IDH (sIDH) versus asymptomatic IDH (aIDH) in prevalent HD and HDF patients.

Main Methods:

• Secondary analysis of the HOLLANT study, a randomized cross-over trial comparing four dialysis modalities.
• Blood pressure was measured every 15 minutes and during symptoms; symptoms were documented real-time, and PID-PROMs collected post-modality.
• IDH was threshold-defined (systolic BP < 90 or < 100 mm Hg), and data from all modalities were pooled.

Main Results:

• 222 IDH episodes (20.1% of treatments) were observed, with 98% being asymptomatic.
• Real-time symptoms occurred in 5.2% of sessions, with only 4 episodes meeting threshold criteria.
• Associations between IDH and PID-PROMs were largely absent.

Conclusions:

• Asymptomatic IDH (aIDH) significantly exceeds symptomatic IDH (sIDH), meaning symptom-based definitions underestimate its incidence.
• Real-time symptoms and PID-PROMs show only occasional association with IDH events.
• Current definitions may not fully capture the burden of IDH, particularly asymptomatic cases.