Intradialytic Hypotension in Two Sudanese Hemodialysis Centers During the 2023 Armed Conflict: A Cross-Sectional Study

BackgroundIntradialytic hypotension (IDH) is a frequent hemodialysis complication associated with symptoms, inadequate fluid removal, and adverse cardiovascular outcomes.Evidence from Sudan is limited, particularly during the health-system disruption caused by the 2023 armed conflict.This study assessed the prevalence, associated factors, clinical manifestations, and management of IDH in two Sudanese dialysis centers. MethodologyWe conducted a hospital-based, cross-sectional study from March to August 2023 among 111 adults with end-stage kidney disease receiving hemodialysis at Soba Teaching Hospital, Khartoum (n = 30), and Port Sudan Center for Dialysis and Kidney Surgery (n = 81).Data were collected using a structured intervieweradministered questionnaire.IDH was operationally defined as a decrease in systolic blood pressure of at least 20 mmHg or a decrease in mean arterial pressure of at least 10 mmHg accompanied by symptoms during hemodialysis.Associations were examined using chi-square tests and multivariable logistic regression, with p-values <0.05 considered statistically significant. ResultsIDH was reported in 74 (66.7%) participants.Among affected patients, 55 (74.3%) experienced hypotension during the third to fourth hours of dialysis.The most frequent manifestations were sweating (66.2%), fatigue (48.6%), nausea (35.1%), vomiting (32.4%), and muscle cramps (14.9%).Hypertension (p = 0.036) and low body mass (p = 0.048) were associated with IDH in bivariable analysis.After adjustment, hypertension remained independently associated with IDH (adjusted odds ratio = 2.70, 95% confidence interval = 1.09-7.80;p = 0.04).Normal saline until recovery was the only documented management strategy. ConclusionsIDH represented a substantial clinical burden in these dialysis centers.Standardized, individualized prevention and management protocols, including careful volume assessment, ultrafiltration optimization, and systematic monitoring of high-risk patients, are warranted, particularly in resource-constrained and conflict-affected settings.