Higher pre-hemodialysis serum phosphate was independently associated with an increased risk of intradialytic hypotension (aOR 1.12 per 1 mg/dl increase; 95% CI 1.10-1.13; p<0.001).
Cohort (n=2,807)
Yes
Is higher pre-hemodialysis serum phosphate associated with an increased risk of intradialytic hypotension in hemodialysis patients?
Higher pre-hemodialysis serum phosphate is independently associated with an increased risk of intradialytic hypotension.
Odds Ratio: 1.12 (95% CI 1.1–1.13)
p-value: p=<0.001
INTRODUCTION: Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD) and is associated with excess morbidity and mortality. Higher serum phosphate is associated with adverse cardiovascular outcomes in maintenance HD patients; however, its association with IDH has not previously been assessed. METHODS: This is an analysis of a prospective cohort of 969 HD patients (80,968 HD sessions) receiving HD at a large dialysis organization (LDO) and a post-hoc analysis of 1838 HD patients (10,594 HD sessions) in the Hemodialysis study (HEMO), a multicenter randomized controlled trial that examined standard or high-dose HD and low-flux or high-flux membranes. Unadjusted and adjusted mixed effects regression models were fit to determine the association of pre-HD serum phosphate with IDH, defined as a nadir intra-HD systolic blood pressure (SBP) <90 mmHg. FINDINGS: In the LDO cohort, baseline mean pre-HD serum phosphate was 5.2 ± 1.7 mg/dl. IDH occurred in 15.6% of HD sessions. In the adjusted model, higher pre-HD serum phosphate (per 1 mg/dl) was associated with a 12% increased risk of IDH (aOR 1.12, 95% CI 1.10-1.13, p <0.001). In exploratory models where pre-HD laboratory values were available, the effect estimate was attenuated but remained statistically significant (aOR 1.05; 95% CI 1.02-1.08; p <0.01). Participants in the highest (compared with the lowest) quartile of pre-HD serum phosphate had a 56% greater risk of IDH in the adjusted model (aOR Q4:Q1 1.56; 95% CI 1.44-1.68, p <0.001). The association of higher phosphate with IDH was consistent in the HEMO data. DISCUSSION: Higher pre-HD serum phosphate is independently associated with an increased risk of IDH. As HD may cause an acute decline in serum phosphate, future studies to investigate the mechanisms of this association are warranted.
Ravi et al. (Thu,) conducted a cohort in Hemodialysis (n=2,807). Higher pre-hemodialysis serum phosphate vs. Lower pre-hemodialysis serum phosphate was evaluated on Intradialytic hypotension (IDH), defined as a nadir intra-HD systolic blood pressure (SBP) <90 mmHg (aOR 1.12, 95% CI 1.10-1.13, p=<0.001). Higher pre-hemodialysis serum phosphate was independently associated with an increased risk of intradialytic hypotension (aOR 1.12 per 1 mg/dl increase; 95% CI 1.10-1.13; p<0.001).