Systolic blood pressure change between before and 2 hours after dialysis may predict intradialytic hypotension in diabetic ESRD patients

초록

Purpose : Intradialytic hypotension (IDH) is the most frequent complication of hemodialysis (HD). However, its development is unpredictable. We investigated whether the degree of systolic blood pressure (SBP) reduction during first 2 hours predict IDH in hypotension-prone HD patients. Methods : We included 5 IDH-prone patients. IDH defined as the occurrence of SBP < 100 mmHg during HD or SBP drop > 100 mmHg (compared to o hr). Patients with infection, liver cirrhosis and congestive heart failure, Inadequate BP data during HD session, HD sessions with taking alpha agonist(Midron) or of < 3 hrs were excluded. About 1 years of HD records were reviewed and divided into IDH and non-IDH sessions. As control, 719 HD records of 5 patients without IDH were also reviewed. Results : Five patients were included. All were female diabetics with ages of 61+6 years and HD durations of 4.5+1.9 years. Total 719 sessions of HD (143.8 sessions/patient) were included in this study. Among them, 104 sessions were IDH. SBPs were significantly lower in IDH than in non-IDH sessions throughout HD (180+28 vs. 180+22 mmHg at 0 hr; 150+25 vs. 163+23 mmHg at 1 hr ; 137+26 vs. 163+24 mmHg at 2 hr ; 118+23 vs. 158+25 mmHg at 3 hr ; and 109+26 vs. 154+27 mmHg at 4 hr ). The changes of SBP between 0 and 1 hr (29.9+26.5 vs. 16.2+22.1 mmHg), between 0 and 2 hr (42.8+32.8 vs. 16.6+28.7 mmHg) were significantly higher in IDH than in non-IDH sessions. On logistic regression analysis, independent predictors of IDH were the changes of body weight (dBW), followed by the changes of SBP between 0 and 2 hrs (dSBP02), and pre-HD SBP. dSBP02 were significantly correlated with dBW (r=0.255, p=0.001) in IDH-prone 5 patients. Receiver operating curve analysis showed that dSBP02 was 0.67. However, dSBP02 were not correlated with dBW in control HD patients (r=-0.06, p=0.085). Conclusion : UF amount during first hour was the strongest variable. The cutoff value was 0.74 liter/hour.