Factors contributing to hypotension during hemodialysis

Abstract

Background

The characteristics of patients receiving chronic hemodialysis in the United States has continuously changed over the past three decades. Today the patients are older, and the incidence of diabetic nephropathy has markedly increased. Hypotension during hemodialysis is the most common and bothersome complication of chronic hemodialysis. The demographics of those patients who experience hypotension during dialysis has not been previously identified.

Methods

The change in systolic pressure during hemodialysis was reviewed for ten consecutive hemodialysis treatments in 134 patients in a single hospital-based unit. For the past four years, those patients who have had symptoms during their hypotensive episodes associated with hemodialysis have been under continuous therapy with midodrine.

Results

In the present study, the overall incidence of patients experiencing decreases of, at least, 40 mmHg systolic pressure, in over 50% of their treatments, is 63%. The incidence of patients having symptoms from hypotension during hemodialysis is 25%. Analysis of the dialysis population shows that the age of the patients is a primary factor leading to hypotension. Diabetic nephropathy is identified as a second risk factor for hypotension. However, the incidence in the asymptomatic group versus the symptomatic group was not statistically significant. In the group of patients (25%) who have hypotension during hemodialysis with clinical symptoms, all had hypertension requiring therapy prior to initiating hemodialysis. Hypertension may be a predisposing factor to the development of hypotension. Females tended to have more hypotension during dialysis than males.

Conclusions

As a result of the increasing age of patients receiving hemodialysis and the increasing incidence of diabetic nephropathy, hypotension will become an even greater problem in the future.