Kidney Week

Abstract: SA-PO370

Associations of Body Compositions, Intradialytic Hypotension, and Mortality in Hemodialysis Patients

Session Information

• Hemodialysis and Frequent Dialysis: CV and Risk Prediction
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Mizuiri, Sonoo, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan

Sonoo Mizuiri,

• Nishizawa, Yoshiko, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan

Yoshiko Nishizawa,

• Doi, Toshiki, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan

Toshiki Doi,

• Yamashita, Kazuomi, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan

Kazuomi Yamashita,

• Shigemoto, Kenichiro, Iryo Hojin Ichiyokai Harada Byoin, Hiroshima, Japan

Kenichiro Shigemoto,

• Usui, Koji, Ichiyokai Ichiyokai Clinic, Hiroshima, Japan, Japan

Koji Usui,

• Naito, Takayuki, Ichiyokai Yokogawa Clinic, Hiroshima, Japan, Japan

Takayuki Naito,

• Arita, Michiko, Ichiyokai East Clinic, Hiroshima, Japan, Japan

Michiko Arita,

• Masaki, Takao, Hiroshima Daigaku Byoin, Hiroshima, Hiroshima, Japan

Takao Masaki,

Background

Intradialytic hypotension (IDH) is a serious complication of hemodialysis. We studied the relationship among body composition, intradialytic hypotension, and mortality in dialysis patients.

Methods

Subjects were maintenance hemodialysis (HD) patients. The study timeline included the baseline (day 1), exposure assessment period (days 1–22), and outcome assessment period (day 23–3 years). IDH was defined as a nadir systolic blood pressure (SBP) <90 mmHg for at least two of ten HD sessions during the exposure assessment period. Clinical data at baseline and post-dialysis body composition parameters using bioimpedance spectroscopy in days 1–22 were assessed. Patients were divided into IDH and non-IDH groups. Kaplan–Meier curves and Cox proportional hazard models were used to assess patient survival.

Results

Overall (n=306), age, dialysis duration, and diabetes (DM) prevalence were 65±12 years, 108±100 months, and 42%, respectively. The IDH group (n=30) showed significantly (P <0.05) lower serum albumin and intracellular water (ICW) (14.7±3.6 vs. 16.2±3.7 L) levels and lower lean tissue index (LTI) (11.7±2.7 vs. 12.3±2.6 kg/m², P=0.06) but higher extracellular/intracellular (E/I) water (0.96±0.17 vs. 0.92±0.13, P=0.16) compared with those in the non-IDH group (n=276). Fifty all-cause deaths and 11 cardiovascular (CV) deaths occurred over 3 years. ICW (odds ratio [OR] 0.78), LTI (OR 0.79), and E/I (OR 27.52) were significant predictors for IDH, independent of age, pre-dialysis SBP, and ultrafiltration volume (P <0.05). Patients were also grouped based on the mortality cut-off values for ICW, LTI and E/I. Patients with ICW ≥13.6 L, LTI ≥15.5 kg/m², and E/I <0.90 showed significantly higher 3-year Kaplan–Meier survival curves than those in the other groups (P <0.05). Cox models (adjusted for DM and dialysis duration) showed that ICW, LTI, E/I, and IDH were significant predictors for all-cause mortality (P <0.01). After adjusting for DM, dialysis duration, age, sex, CV diseases, serum albumin, C-reactive protein, phosphate, and magnesium levels, only IDH was a significant predictor for 3-year all-cause and CV mortality (P <0.05).

Conclusion

Associations between IDH, body composition, and mortality were confirmed, and an optimal body composition to prevent IDH needs to be determined.

Funding

• Private Foundation Support