Enfermedades cardiovasculares y diagnóstico

Risk of Intradialytic Hypotension in Hemodialysis Patients with Different Residual Urine Volume

Abstract

Qishu Li, Xianfeng Wu, Weiping Tu

Background: Relationship between intradialytic hypotension (IDH) and residual urine volume (RUV) in hemodialysis (HD) patients remained unclear. In the present study, we aimed to evaluate the risk of intradialytic hypotension in hemodialysis patients with different residual urine volume.

Method: This work was a prospective observational study of incident and prevalent HD patients. From January 1, 2013 to February 28, 2014, patients were recruited from a single HD center of the Second Affiliated Hospital of Nanchang University. Eligible patients were categorized into three groups: group A (RUV > 400 ml/24 hours), group B (RUV of 100-400 ml/24 hours) and group C (RUV < 100 ml/24 hours). A Logistic regression model was used to examine patient characteristics associated with predictive odds of RUV with 100-400 ml/24 hours and < 100 ml/24 hours. Hazard ratio (HR) of IDH was calculated by the Cox proportional hazards model for three groups.

Results: Totally, 150 HD patients were enrolled in this study, with mean follow-up of 9.9 ± 5.1 months. Older age, longer HD vintage and lower levels of hemoglobin were independently associated with RUV with 100-400 ml/24 hours, whereas thrice-weekly HD, longer HD vintage, diabetes and lower levels of phosphate were independently associated with RUV < 100 ml/24 hours in the study patients by multivariate Logistic regression analysis. During the follow-up period, 17.3% (26/150) patients developed IDH events, including 8.2% (5/61) in the group A, 15.9% (7/44) in the group B and 31.1% (14/45) in the group C. IDH incidence was significantly difference among three groups. Patients with RUV < 100 ml/24 hours had higher risk of IDH than those with RUV > 400 ml/24 hours, even when extensive demographics, comorbidities and lab adjustments were made. Similarly, in a maximally adjusted model, risk of IDH in patients with RUV of 100-400 ml/24 hours was 2.36 times than that in those with RUV > 400 ml/24 hours (95% CI 1.75-7.47, p=0.043).

Conclusion: HD patients with lower RUV may have an increased risk of presenting IDH, which suggested that preserving RUV may be conducive to preventing of IDH occurrence.