Abstract: SA-PO866
Pre-Dialysis Serum Phosphorus and Intradialytic Hypotension
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
- Reeves, Patrick, Brigham and Women's Hospital, Boston, Massachusetts, United States
- Waikar, Sushrut S., Brigham and Women's Hospital, Boston, Massachusetts, United States
- McCausland, Finnian R., Brigham and Women's Hospital, Boston, Massachusetts, United States
Background
Intradialytic hypotension (IDH) is a common complication of maintenance hemodialysis (HD) and is associated with excess morbidity and mortality. Higher serum phosphorus is associated with vascular calcification and adverse cardiovascular outcomes, however its association with the development of IDH is unclear. We hypothesized that higher pre-dialysis serum phosphorus is associated with a higher risk of IDH.
Methods
We performed a post-hoc analysis in 1825 participants (n=10,551 HD sessions) from the Hemodialysis (HEMO) Study, a multicenter randomized control trial examining standard or high dose dialysis and low-flux or high-flux membranes. Unadjusted and adjusted generalized linear models were fit to determine the association of pre-dialysis serum phosphorus with IDH (defined as any hypotensive event requiring an intervention). Serum phosphorus was examined as a continuous and categorical variable to assess for non-linear associations.
Results
Mean age of participants was 57.8 years (43.8% men, 37.4% white). Mean pre-dialysis serum phosphorus was 5.8 mg/dL; IDH occurred in 17.5% of HD sessions. In adjusted models (accounting for age, sex, race, comorbidities, flux group, Kt/V group, dialysis vintage, session length, ultrafiltration volume, access, pre-dialysis blood pressure, and pre-dialysis laboratory tests), higher pre-dialysis serum phosphorus (per 1 mg/dL) was associated with a higher risk of IDH (odds ratio (OR) 1.07; 95% confidence interval (CI) 1.03-1.12). Participants in the highest (≥ 6.9 mg/dL) vs. lowest (≤ 4.5 mg/dL) quartile of pre-dialysis serum phosphorus had a 30% greater risk (OR 1.30; 95% CI 1.05-1.60) of IDH (Figure 1).
Conclusion
Higher pre-dialysis serum phosphorus is independently associated with higher risk of IDH, even after adjustment for variables associated with ‘compliance’. As HD may cause an acute decline in serum phosphorus, future studies to investigate the temporal association of changes in phosphorus and IDH should be performed.
Funding
- Other NIH Support