BACKGROUND AND OBJECTIVES: Patients undergoing hemodialysis have an elevated risk of cardiovascular disease-related morbidity and mortality compared with the general population. Intradialytic hypotension (IDH) is estimated to occur during 20%-30% of hemodialysis sessions. To date, no large studies have examined whether IDH is associated with cardiovascular outcomes. This study determined the prevalence of IDH according to interdialytic weight gain (IDWG) and studied the association between IDH and outcomes for cardiovascular events and mortality to better understand its role. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study retrospectively examined records of 39,497 hemodialysis patients during 2007 and 2008. US Renal Data System claims and dialysis provider data were used to determine outcomes. IDH was defined by current Kidney Disease Outcomes Quality Initiative guidelines (≥20 mmHg fall in systolic BP from predialysis to nadir intradialytic levels plus ≥2 responsive measures [dialysis stopped, saline administered, etc.]). IDWG was measured absolutely (in kilograms) and relatively (in percentages). RESULTS: IDH occurred in 31.1% of patients during the 90-day exposure assessment period. At baseline, the higher the IDWG (relative or absolute), the greater the frequency of IDH (P<0.001). For all-cause mortality, the median follow-up was 398 days (interquartile range, 231-602 days). Compared with patients without IDH, IDH was associated with all-cause mortality (7646 events; adjusted hazard ratio, 1.07 [95% confidence interval, 1.01 to 1.14]), myocardial infarction (2396 events; 1.20 [1.10 to 1.31]), hospitalization for heart failure/volume overload (8896 events; 1.13 [1.08 to 1.18]), composite hospitalization for heart failure/volume overload or cardiovascular mortality (10,805 events; 1.12 [1.08 to 1.17]), major adverse cardiac events (MACEs; myocardial infarction, stroke, cardiovascular mortality) (4994 events, 1.10 [1.03 to 1.17]), and MACEs+ (MACEs plus arrhythmia or hospitalization for heart failure/volume overload) (12,221 events; 1.14 [1.09 to 1.19]). CONCLUSIONS: IDH was potently associated with cardiovascular morbidity and mortality. Clinical trials to ascertain causality are needed and should consider reduction in IDWG as a potential means to reduce IDH.
BACKGROUND AND OBJECTIVES:Patients undergoing hemodialysis have an elevated risk of cardiovascular disease-related morbidity and mortality compared with the general population. Intradialytic hypotension (IDH) is estimated to occur during 20%-30% of hemodialysis sessions. To date, no large studies have examined whether IDH is associated with cardiovascular outcomes. This study determined the prevalence of IDH according to interdialytic weight gain (IDWG) and studied the association between IDH and outcomes for cardiovascular events and mortality to better understand its role. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: This study retrospectively examined records of 39,497 hemodialysis patients during 2007 and 2008. US Renal Data System claims and dialysis provider data were used to determine outcomes. IDH was defined by current Kidney Disease Outcomes Quality Initiative guidelines (≥20 mmHg fall in systolic BP from predialysis to nadir intradialytic levels plus ≥2 responsive measures [dialysis stopped, saline administered, etc.]). IDWG was measured absolutely (in kilograms) and relatively (in percentages). RESULTS: IDH occurred in 31.1% of patients during the 90-day exposure assessment period. At baseline, the higher the IDWG (relative or absolute), the greater the frequency of IDH (P<0.001). For all-cause mortality, the median follow-up was 398 days (interquartile range, 231-602 days). Compared with patients without IDH, IDH was associated with all-cause mortality (7646 events; adjusted hazard ratio, 1.07 [95% confidence interval, 1.01 to 1.14]), myocardial infarction (2396 events; 1.20 [1.10 to 1.31]), hospitalization for heart failure/volume overload (8896 events; 1.13 [1.08 to 1.18]), composite hospitalization for heart failure/volume overload or cardiovascular mortality (10,805 events; 1.12 [1.08 to 1.17]), major adverse cardiac events (MACEs; myocardial infarction, stroke, cardiovascular mortality) (4994 events, 1.10 [1.03 to 1.17]), and MACEs+ (MACEs plus arrhythmia or hospitalization for heart failure/volume overload) (12,221 events; 1.14 [1.09 to 1.19]). CONCLUSIONS: IDH was potently associated with cardiovascular morbidity and mortality. Clinical trials to ascertain causality are needed and should consider reduction in IDWG as a potential means to reduce IDH.
Authors: Daniel E Weiner; Hocine Tighiouart; Manish G Amin; Paul C Stark; Bonnie MacLeod; John L Griffith; Deeb N Salem; Andrew S Levey; Mark J Sarnak Journal: J Am Soc Nephrol Date: 2004-05 Impact factor: 10.121
Authors: Michael Walsh; Philip J Devereaux; Amit X Garg; Andrea Kurz; Alparslan Turan; Reitze N Rodseth; Jacek Cywinski; Lehana Thabane; Daniel I Sessler Journal: Anesthesiology Date: 2013-09 Impact factor: 7.892
Authors: B G Stegmayr; M Brannstrom; S Bucht; E Dimeny; A Ekspong; B Granroth; K C Grontoft; H Hadimeri; B Holmberg; B Ingman; B Isaksson; G Johansson; K Lindberger; L Lundberg; O Lundstrom; L Mikaelsson; M Mortzell; E Olausson; B Persson; L Svensson; A M Wikdahl Journal: Int J Artif Organs Date: 2006-07 Impact factor: 1.595
Authors: Alexandru Burlacu; Simonetta Genovesi; Carlo Basile; Alberto Ortiz; Sandip Mitra; Dimitrios Kirmizis; Mehmet Kanbay; Andrew Davenport; Frank van der Sande; Adrian Covic Journal: J Nephrol Date: 2020-05-29 Impact factor: 3.902
Authors: Rammah Abohtyra; Yossi Chait; Michael J Germain; Christopher V Hollot; Joseph Horowitz Journal: IEEE Trans Biomed Eng Date: 2018-12-04 Impact factor: 4.538
Authors: Magdalene M Assimon; M Alan Brookhart; Jason P Fine; Gerardo Heiss; J Bradley Layton; Jennifer E Flythe Journal: Am J Kidney Dis Date: 2018-04-10 Impact factor: 8.860
Authors: Tara I-Hsin Chang; Sai Liu; Medha Airy; Jingbo Niu; Mintu P Turakhia; Jennifer E Flythe; Maria E Montez-Rath; Wolfgang C Winkelmayer Journal: Clin J Am Soc Nephrol Date: 2019-06-07 Impact factor: 8.237
Authors: Jason A Chou; Elani Streja; Danh V Nguyen; Connie M Rhee; Yoshitsugu Obi; Jula K Inrig; Alpesh Amin; Csaba P Kovesdy; John J Sim; Kamyar Kalantar-Zadeh Journal: Nephrol Dial Transplant Date: 2018-01-01 Impact factor: 5.992
Authors: Dana C Miskulin; Jennifer Gassman; Ronald Schrader; Ambreen Gul; Manisha Jhamb; David W Ploth; Lavinia Negrea; Raymond Y Kwong; Andrew S Levey; Ajay K Singh; Antonia Harford; Susan Paine; Cynthia Kendrick; Mahboob Rahman; Philip Zager Journal: J Am Soc Nephrol Date: 2017-12-06 Impact factor: 10.121