Orthostatic Hypotension: A Risk Factor for Mortality in Patients with End-Stage Kidney Disease on Maintenance...

To determine the effect of pre- and post-dialysis orthostatic hypotension (OH) on mortality among patients with end-stage kidney disease (ESKD) undergoing maintenance haemodialysis (MHD).

A prospective comparative study. Place and Duration of the Study: Department of Nephrology, Mayo Hospital, King Edward Medical University, Lahore, Pakistan, from March to August 2024.

A total of 95 patients undergoing MHD were selected based on the inclusion criteria. Data were collected on three consecutive haemodialysis (HD) sessions. On the first visit, after taking informed consent, the complete history was recorded along with laboratory parameters on a predefined pro forma. On each visit, pre- and post-dialysis supine and standing blood pressure (BP) readings were recorded. Patients were divided into Group A (patients with OH) and Group B (patients without OH). Patients were followed up for 6 months for all-cause mortality. Student's t-test and the Mann-Whitney U test were used for comparisons. Survival was analysed using the Kaplan-Meier curve.

Out of 95, 16 (16.84%) patients were diagnosed with OH (Group A) while 79 (83.16%) were non-OH patients (Group B). The two groups showed no significant difference in demographic, clinical, and laboratory parameters (including markers of inflammation, nutrition, and mineral metabolism). Compared to Group B, Group A had more males (p = 0.022), patients with diabetic kidney disease (p = 0.040), a high rate of loss of consciousness (p = 0.001), and mortality (p = 0.015). After applying logistic regression test on different categorical variables, it was found that gender (p = 0.034), lower monthly income (p = 0.023), and shortness of breath (p = 0.049) were all significant positive predictors of OH.

The presence of OH significantly increases mortality in ESKD patients on MHD.

Orthostatic hypotension, End-stage renal disease, Haemodialysis.