Abstract: TH-OR32
Intradialytic Hypotension and Mortality in Children and Young Adults
Session Information
- Pediatric Nephrology: From Bench to Bedside
November 03, 2022 | Location: W307, Orange County Convention Center‚ West Building
Abstract Time: 05:06 PM - 05:15 PM
Category: Pediatric Nephrology
- 1800 Pediatric Nephrology
Authors
- Zhao, Xixi, Stanford University, Stanford, California, United States
- Chang, Tara I., Stanford University, Stanford, California, United States
- Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
- Marsenic, Olivera, Stanford University, Stanford, California, United States
Background
Intradialytic hypotension (IDH) is associated with mortality in adult patients requiring hemodialysis (HD), however large-scale pediatric studies are lacking. Moreover, there is no evidence-based consensus definition of IDH in the pediatric literature. We aimed to test whether a similar relationship between IDH and mortality existed in children and young adult patients, and if so, which IDH definition captured that association best.
Methods
We studied 1,581 patients (ages 1-21 years old) receiving HD at a large dialysis organization to investigate the associations of commonly used IDH definitions with mortality. IDH definitions were selected a priori based on a literature review (Table 1). Patients were classified as having IDH if they experienced IDH in at least 30% of HD treatments.
Results
IDH did not associate with mortality in any of the commonly used IDH definitions after adjusting for age, race, cause of end-stage kidney disease, predialysis systolic blood pressure (SBP), and ultrafiltration rate (Figure 1). Subgroup analysis by age (<18 and 19-21 years old) and predialysis SBP (<120, 120-150, >150 mmHg) did not demonstrate an association with mortality either. We then examined the occurrence of IDH in <5%, 5-29%, 30-50%, and >50% of baseline treatments, and did not find a dose-response association of IDH with mortality.
Conclusion
IDH was not independently associated with mortality in children and young adults, contrary to the findings in adults. Future studies will examine the association of IDH with outcomes other than death, and mechanisms that may allow this population to better tolerate IDH.
IDH definitions
| Term | Definition |
| 5th percentile | 70 + (2 x age) |
| 50th percentile | 90 + (2 x age) |
| 20 drop | (Predialysis SBP – nadir intradialytic SBP) > 20 mmHg |
| 30 drop | (Predialysis SBP – nadir intradialytic SBP) > 30 mmHg |
| SBP<90 | Nadir intradialytic SBP<90 mmHg |
| SBP<100 | Nadir intradialytic SBP<100 mmHg |
| 20 drop + SBP<90 | (Predialysis SBP – nadir intradialytic SBP) > 20 mmHg and nadir intradialytic SBP<90 mmHg |
| 30 drop + SBP<90 | (Predialysis SBP – nadir intradialytic SBP) > 30 mmHg and nadir intradialytic SBP<90 mmHg |