Clinical Profile and Short-Term Outcomes of Patients With Intradialytic Hypertension Undergoing Maintenance Hemodialysis in a Tertiary Care Centre: A Prospective Cohort Study

TL;DR

This study finds that intradialytic hypertension during hemodialysis is common and linked to worse outcomes like hospitalization and mortality.

Contribution

The study provides new insights into IDH incidence and its clinical associations in a developing country tertiary care setting.

Findings

IDH occurred in 27.2% of hemodialysis patients.

IDH patients had higher rates of adverse events, hospitalization, cardiovascular events, and mortality.

IDH was associated with older age, diabetes, and abnormal biochemical parameters.

Abstract

Introduction

Intradialytic hypertension (IDH) is an underrecognized complication during hemodialysis that has been associated with major adverse cardiovascular events (MACE) and mortality. Prospective studies from tertiary centers in developing countries are limited. The present study was carried out to assess the incidence of IDH and its association with demographic and clinical characteristics and short-term outcomes among patients receiving maintenance hemodialysis.

Materials and methods

In this prospective cohort study, 103 adult patients receiving maintenance hemodialysis were followed for six months at Madras Medical College and Rajiv Gandhi Government General Hospital, a tertiary care institution in South India. Blood pressure data were taken before, during, and after dialysis sessions. IDH was defined as a ≥10 mmHg rise in systolic blood pressure between pre- and post-dialysis in at least two consecutive sessions. Clinical, biochemical, and dialysis-related characteristics were compared between the IDH and non-IDH groups. Intradialytic adverse events, hospitalization, cardiovascular events, and mortality were the outcomes reported.

Results

The incidence of IDH was 27.2%. IDH patients were older, had higher BMI, had longer dialysis history (all p < 0.01), and were more likely to have diabetes, coronary artery disease, and a previous stroke. They had lower hemoglobin, calcium levels, and greater sodium and phosphorus levels (p < 0.01). Dialysate sodium, ultrafiltration volume and rate, interdialytic weight increase, and dialysate temperature were all significantly higher in the IDH group (p < 0.001). IDH was associated with increased intradialytic adverse events (55.6% vs 21.2%), hospitalization (60.0% vs 19.3%), cardiovascular events (58.8% vs 20.9%), and mortality (66.7% vs 23.9%) (all p < 0.05). The survival analysis revealed significantly reduced cardiovascular event-free, hospitalization-free, and overall survival.

Conclusion

IDH affected more than one-quarter of patients and was significantly associated with adverse short-term outcomes in patients undergoing maintenance hemodialysis.

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