The Effect of Frequent and Occasional Dialysis-Associated Hypotension on Survival of Patients on Hemodialysis
Abstract:Frequent or occasional symptomatic intradialytic hypotension during hemodialysis may influence patients' well being, but its effects on survival, independent of comorbidities, have not previously been investigated. Objective:
To assess the effect of frequent (f-IDH) or occasional (o-IDH) dialysis-associated hypotension on survival. Methods:
During the run in period in 1998, 77 patients with f-IDH (≥10 hypotensive events/10 months, responding only to medical intervention) and 101 patients with o-IDH (1 or 2 events/10 months) were identified among all 958 prevalent chronic hemodialysis patients of a network. Eighty-five patients who had no hypotensive episodes (no-IDH) served as controls. Patients were followed for a median of 27 months (range 0.3–37), and survival of patients was compared by log-rank test. Independent association of f-IDH and o-IDH on survival, compared to no-IDH, was assessed by proportional hazards model that included patient's demographics, laboratory data, comorbidity as well as medications. Results:
Forty-five patients (58%) with f-IDH, 47 (47%) with o-IDH, and 33 (39%) with no-IDH died during the follow up that represents mortality rates of 37 (p = 0.013 vs. no-IDH), 26 (p = 0.375 vs. no-IDH), and 21 deaths/100 patient years in the three groups, respectively. In multivariate proportional hazards regression, where age, sex, time on dialysis, CHD, diabetes, Kt/V, albumin level, use of beta-blockers, calcium-channel blockers, and long-acting nitrates have been adjusted for, neither f-IDH nor o-IDH was associated with survival. Conclusion:
Mortality in patients with f-IDH is significantly higher than in those without such events. Our data, however, did not provide evidence that f-IDH, independent of age and comorbidities, contributes to mortality in these patients.
Document Type: Research Article
Affiliations: EuroCare Nephrological Network, 1st Department of Medicine, Semmelweis University, Budapest, Hungary.
Publication date: 2004-01-01