Does intradialytic hypotension increase the risk of cardiovascular morbidity and mortality in hemodialysis patients?
Intradialytic hypotension is significantly associated with increased cardiovascular morbidity and mortality in hemodialysis patients.
BACKGROUND AND OBJECTIVES: Patients undergoing hemodialysis have an elevated risk of cardiovascular disease-related morbidity and mortality compared with the general population. Intradialytic hypotension (IDH) is estimated to occur during 20%-30% of hemodialysis sessions. To date, no large studies have examined whether IDH is associated with cardiovascular outcomes. This study determined the prevalence of IDH according to interdialytic weight gain (IDWG) and studied the association between IDH and outcomes for cardiovascular events and mortality to better understand its role. DESIGN, SETTING, PARTICIPANTS, adjusted hazard ratio, 1.07 95% confidence interval, 1.01 to 1.14), myocardial infarction (2396 events; 1.20 1.10 to 1.31), hospitalization for heart failure/volume overload (8896 events; 1.13 1.08 to 1.18), composite hospitalization for heart failure/volume overload or cardiovascular mortality (10,805 events; 1.12 1.08 to 1.17), major adverse cardiac events (MACEs; myocardial infarction, stroke, cardiovascular mortality) (4994 events, 1.10 1.03 to 1.17), and MACEs+ (MACEs plus arrhythmia or hospitalization for heart failure/volume overload) (12,221 events; 1.14 1.09 to 1.19). CONCLUSIONS: IDH was potently associated with cardiovascular morbidity and mortality. Clinical trials to ascertain causality are needed and should consider reduction in IDWG as a potential means to reduce IDH.
Stefánsson et al. (Fri,) studied this question.