Abstract: SA-PO888
Intradialytic Hypotension in Hospitalized Patients: Does the Definition Matter?
Session Information
- Dialysis: Cardiovascular, BP, Volume
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 701 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Macedo, Etienne, University of California San Diego Medical Center, La Jolla, California, United States
- Karl, Bethany E., University of California San Diego Medical Center, La Jolla, California, United States
- Lee, Euyhyun, University of California San Diego Medical Center, La Jolla, California, United States
- Jacinto, Lea Descallar, University of California San Diego Medical Center, La Jolla, California, United States
- Mehta, Ravindra L., University of California San Diego Medical Center, La Jolla, California, United States
Background
Intradialytic hypotension (IDH) is a frequent, occurring from 15 to 50% of ambulatory sessions, and more frequent among hospitalized patients. Several complications can be associated with IDH: vascular access thrombosis, inadequate dialysis dose, fluid administration, early hemodialysis (HD) termination and mortality. Recently a large epidemiologic study, have shown that an absolute nadir systolic blood pressure (SBP)<90 mmHg was associated with mortality. However, several different definitions continue to be used in the literature and the clinical practice, preventing the appreciation of the effects of IDH and patient outcomes.
Methods
Patients from a prospective interventional study that included patients with albumin < 3 g/dl with AKI or ESRD who required fluid removal with HD were analyzed. Vital signs and ultrafiltration removal rate were recorded every 15 to 30 minutes during HD. The dialysis nurse recorded all symptoms associated with hypotension as well as interventions during the dialysis. We utilized 7 different classifications to determine hypotensive episodes.
Results
65 patients completed 249 sessions; mean age was 58 (+/-12), 46 (70%) were male with a mean weight of 76 (+/-18) kg. Mean SBP and diastolic (DBP) at dialysis initiation were 126 (+/- 25) and 67.38 (+/-17), respectively. Presence of hypotension episode during a session varied from 12 (4.9%) to 111 (44%) according to the definition applied (Table). The HEMO definition, considering hypotension when an intervention results from an unspecific fall in BP, was more liberal, and occurred 50% more frequently than the KDOQI definition. Of the sessions with an absolute intradialytic nadir SBP<90 mmHg, only 30(56%) were followed by an intervention.
Conclusion
Intradialytic hypotension definitions that considered symptoms and interventions often miss episodes of hypotension that have been shown to be associated with increased mortality. Nadir based definitions of hypotension should trigger planned interventions and active questioning about symptoms, especially in hospitalized patients.
Intradialytic hypotension definition and frequency
| Term | Definition | Sessions N(%) | Interventions N(%) |
| Nadir90 | Min IHD SBP< 90 mmHg | 53(21) | 30(56) |
| KDOQI | Pre-HD SBP-min IHD ≥ 20 and symptoms of cramping, headache, lightheadedness, vomiting, or chest pain during HD | 28(11) | 18(64) |
| HEMO | Fall in SBP resulting in intervention of UF reduction, blood flow reduction, or saline administration | 42(17) | 42(100) |
Funding
- Commercial Support – Grifols