Key result
Later dialytic week days linked to ~31% higher intradialytic hypotension risk versus the first day.
Why the study?
Intradialytic hypotension is a common complication of hemodialysis associated with higher cardiovascular risk, but its variation by day of the dialysis week is unclear.
Does the day of the dialytic week affect the risk of intradialytic hypotension in adults undergoing thrice-weekly maintenance hemodialysis?
Cohort (n=2,789)
Yes
Does the day of the dialytic week affect the risk of intradialytic hypotension in adults undergoing thrice-weekly maintenance hemodialysis?
Odds Ratio: 1.31 (95% CI 1.19–1.45)
The risk of intradialytic hypotension increases monotonically with later days of the dialytic week in patients on thrice-weekly maintenance hemodialysis.
May warrant closer monitoring later in the dialytic week; leaves open whether schedule modifications reduce risk in hemodialysis.
Intradialytic hypotension (IDH) is a common complication of hemodialysis (HD) and is associated with a higher risk of cardiovascular (CV) events and mortality. CV events are more common on the days of HD, especially following the longer interdialytic interval. We investigated the risk of IDH according to day of HD in adults undergoing in-center, thrice-weekly HD in the Hemodialysis (HEMO) Study (N = 1,837 patients; n = 64,474 sessions), and the DaVita Clinical Research biorepository [BioReG]) (N = 952 patients; n = 61,197 sessions). Random effects logistic regression models assessed the risk of IDH (defined as nadir intra-HD systolic blood pressure [SBP] <90 mm Hg if pre-HD SBP <160 mm Hg, or <100 mm Hg if pre-HD SBP ≥160 mm Hg [Nadir90/100 definition]) according to HD day (Mon/Tue [HD1]; Wed/Thu [HD2]; Fri/Sat [HD3]). Alternative definitions of IDH were explored. Nadir90/100 occurred in 14% of HEMO and 18% of BioReG sessions. A monotonic increase in the risk of IDH was observed for HD2 and HD3, compared with HD1, for all IDH definitions in both cohorts. Compared with HD1, HD2 was associated with a 10% higher risk of Nadir90/100 (adjusted odds ratio, 1.10; 95% CI, 1.03-1.17) and HD3 was associated with a 31% higher risk (adjusted odds ratio, 1.31; 95% CI, 1.19-1.45) in HEMO, with consistent results in BioReG. We observed a monotonic increased risk of IDH with later days of the dialytic week in two separate cohorts. Further research to determine the underlying mechanisms is necessary to guide strategies for IDH prevention.
No takes yet. Share an insight, caveat, or question.
Correa et al. (2021) conducted a cohort in Maintenance hemodialysis (n=2,789). Later days of the dialytic week (HD2 and HD3) vs. First day of the dialytic week (HD1) was evaluated on Intradialytic hypotension (Nadir90/100 definition) (OR 1.31, 95% CI 1.19-1.45). Later days of the dialytic week were associated with a higher risk of intradialytic hypotension compared to the first day, peaking at the third session (adjusted OR 1.31; 95% CI 1.19-1.45).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: