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Pre-dialysis diastolic blood pressure and intradialytic hypotension in patients undergoing maintenance haemodialysis

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Abstract

Background

Intradialytic hypotension is a clinically relevant complication in haemodialysis patients. Pre-dialysis diastolic blood pressure is routinely measured. However, the association between pre-dialysis diastolic blood pressure and intradialytic hypotension is not well understood.

Methods

Patient-level (N = 545) and haemodialysis session-level (N = 3261) data were collected; the exposure variable was pre-dialysis diastolic blood pressure. The primary outcome of interest was the development of intradialytic hypotension, defined as any nadir < 100 mmHg if the pre-dialysis systolic blood pressure was ≥ 160 mmHg, or any nadir < 90 mmHg if the pre-dialysis systolic blood pressure was < 160 mmHg. Odds ratios (ORs) with 95% confidence intervals (CIs) were estimated using mixed-effects logistic regression for the association between pre-dialysis diastolic blood pressure and intradialytic hypotension, after adjusting for potential confounders.

Results

Intradialytic hypotension occurred in 14.4% of the sessions. All sessions were divided into five categories according to pre-dialysis diastolic blood pressure. The adjusted ORs for intradialytic hypotension were 2.72 (95% CI 1.64–4.51), 1.07 (95% CI 0.68–1.66), 1.68 (95% CI 1.08–2.62), and 1.81 (95% CI 1.05–3.14) in sessions with pre-dialysis diastolic blood pressure of < 60 mmHg, ≥ 60 to < 70 mmHg, ≥ 80 to < 90 mmHg, and ≥ 90 mmHg, respectively, compared with the reference pre-dialysis diastolic blood pressure of ≥ 70 to < 80 mmHg. Cubic spline analyses revealed a reverse J-shaped association between pre-dialysis diastolic blood pressure and intradialytic hypotension.

Conclusions

Low and high pre-dialysis diastolic blood pressure levels were associated with intradialytic hypotension. This may help identify patients at a high risk of developing intradialytic hypotension.

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Acknowledgements

We would like to thank the patients and medical staff at the Otowa Kinen Hospital, for their cooperation in this study.

Funding

The authors did not receive support from any organisation for the submitted work.

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Authors and Affiliations

  1. Department of Nephrology, Rakuwakai Otowa Hospital, 2 Otowa-Chinji-cho, Yamashina-ku, Kyoto, 607-8062, Japan

    Takashi Hara, Yuto Kasahara & Takahiko Nakagawa

  2. Department of Biochemistry, Shiga University of Medical Science, Shiga, Japan

    Takahiko Nakagawa

Authors
  1. Takashi Hara
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  2. Yuto Kasahara
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  3. Takahiko Nakagawa
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Contributions

Research idea and study design: TH, YK, and TN; data acquisition: TH, YK, and TN; data analysis/interpretation: TH and YK; statistical analysis: TH and YK; supervision or mentorship: TN. Each author contributed important intellectual content during manuscript drafting or revision and accepts accountability for the overall work by ensuring that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.

Corresponding author

Correspondence to Takashi Hara.

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Conflict of interest

Takashi Hara, Yuto Kasahara, and Takahiko Nakagawa declare no competing interests.

Ethical disclosures

This study was performed in accordance with the ethical standards, the Declaration of Helsinki and its later amendments; IRB approval April 7 2021, approval number: Rakuoto-Rin-21-022, Rakuwakai Otowa Hospital.

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Hara, T., Kasahara, Y. & Nakagawa, T. Pre-dialysis diastolic blood pressure and intradialytic hypotension in patients undergoing maintenance haemodialysis. J Nephrol 35, 1419–1426 (2022). https://doi.org/10.1007/s40620-022-01292-2

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  • DOI: https://doi.org/10.1007/s40620-022-01292-2

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