What question did this study set out to answer?

The aim is to evaluate the predictive value of pleth variability index (PVi) for hypotension during hemodialysis.

April 28, 2026Open Access

The value of pleth variability index in predicting hypotension during maintenance hemodialysis: a prospective observational multicenter study (PVi-HD study)

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Maintenance hemodialysis (n=200). Intervention: Pleth Variability Index (PVi) monitoring vs. Traditional predictors (baseline MAP, ultrafiltration volume). Primary outcome: Predictive performance for intradialytic hypotension (IDH) (HR 7.15, 95% CI 3.86-13.22, p=<0.001).

Key Result

A percentage change in Pleth Variability Index greater than 23.53% during the first hour of hemodialysis was associated with a 7.15-fold higher risk of developing intradialytic hypotension.

Key Points

The aim is to evaluate the predictive value of pleth variability index (PVi) for hypotension during hemodialysis.
Multicenter prospective observational study
Monitoring PVi changes during the first hour of hemodialysis
Assessment of subsequent incidences of intradialytic hypotension (IDH)
Dynamic changes in PVi are independent predictors of subsequent IDH
Monitoring PVi offers a non-invasive method for early risk stratification
Significant correlation between PVi variations and hypotension outcomes observed.

Study Design

Type

Observational (n=200)

Multicenter

Yes

Structured PICO

Does monitoring the Pleth Variability Index (PVi) predict intradialytic hypotension in patients undergoing maintenance hemodialysis?

Population

200 adult patients (aged 18 to 80 years) on chronic maintenance hemodialysis for more than 3 months with stable dialysis regimens. Median age 57.0 years, 55.5% male, based in China. Key exclusions: significant cardiac arrhythmias (e.g., persistent atrial fibrillation), severe peripheral circulation disorders, severe hemodynamic instability during dialysis, and pregnant or breastfeeding women.

Intervention

Monitoring of Pleth Variability Index (PVi) using a pulse oximeter (Philips IntelliVue with Masimo SET module) at baseline and 60 minutes into the hemodialysis session to calculate absolute change (ΔPVi) and percentage change (ΔPVi%).

Outcome

Predictive value of PVi parameters (PVi baseline, PVi 1h, ΔPVi, and ΔPVi%) for intradialytic hypotension, as determined by receiver operating characteristic (ROC) curve analysis.surrogate

Dynamic changes in the Pleth Variability Index (PVi) during the first hour of hemodialysis serve as a strong, non-invasive predictor of intradialytic hypotension, outperforming traditional hemodynamic parameters.

Main Result

Effect estimate: HR 7.15 (95% CI 3.86-13.22)

p-value: p=<0.001

Limitations

Missing laboratory parameters required multiple imputation and exclusion of variables with significant missingness.

Abstract

Dynamic changes in PVi during the first hour of hemodialysis are strong, independent predictors of subsequent IDH. Monitoring PVi changes offers a promising and practical non-invasive tool for early risk stratification.

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Cite This Study

Li et al. (Sat,) conducted a observational in Maintenance hemodialysis (n=200). Pleth Variability Index (PVi) monitoring vs. Traditional predictors (baseline MAP, ultrafiltration volume) was evaluated on Predictive performance for intradialytic hypotension (IDH) (HR 7.15, 95% CI 3.86-13.22, p=<0.001). A percentage change in Pleth Variability Index greater than 23.53% during the first hour of hemodialysis was associated with a 7.15-fold higher risk of developing intradialytic hypotension.

synapsesocial.com/papers/69f04e08727298f751e72029 https://doi.org/https://doi.org/10.1186/s12882-026-04883-4