Kidney International

The time of onset of intradialytic hypotension during a hemodialysis session associates with clinical parameters and mortality.

David F. Keane, Jochen G Raimann, Hanjie Zhang, Joanna L. Willetts, Stephan Thijssen, Peter Kotanko

Intradialytic hypotension (IDH) is a common complication of hemodialysis, but there is no data about the time of onset during treatment. Here we describe the incidence of IDH throughout hemodialysis and associations of time of hypotension with clinical parameters and survival by analyzing data from 21 dialysis clinics in the United States to include 785682 treatments from 4348 patients. IDH was defined as a systolic blood pressure of 90 mmHg or under while IDH incidence was calculated in 30-minute intervals throughout the hemodialysis session. Associations of time of IDH with clinical and treatment parameters were explored using logistic regression and with survival using Cox-regression. Sensitivity analysis considered further IDH definitions. IDH occurred in 12% of sessions at a median time interval of 120-149 minutes. There was no notable change in IDH incidence across hemodialysis intervals (range: 2.6-3.2 episodes per 100 session-intervals). Relative blood volume and ultrafiltration volume did not notably associate with IDH in the first 90 minutes but did thereafter. Associations between central venous but not arterial oxygen saturation and IDH were present throughout hemodialysis. Patients prone to IDH early as compared to late in a session had worse survival. Sensitivity analyses suggested IDH definition affects time of onset but other analyses were comparable. Thus, our study highlights the incidence of IDH during the early part of hemodialysis which, when compared to later episodes, associates with clinical parameters and mortality

About the Contributors

Dr. Peter Kotanko, MD

RRI Research Director

SVP, Corporate Research & Development

Peter Kotanko, MD is Research Director at the Renal Research Institute (RRI), New York. Prior to joining RRI, from 1997 to 2007 he served as Vice Chair of a department of internal medicine at an academic teaching hospital in Graz, Austria. Prior to moving to Graz in 1989, he worked 1982-89 at the Department of Physiology and the University Clinic of Internal Medicine, Innsbruck, Austria...

Jochen G. Raimann, MD, PhD, MPH

Senior Manager, Clinical Data Analytics

Dr. Raimann has worked as a full-time scientist at the Renal Research Institute since his start as a post-doctoral Research Fellow in 2007. Currently as the Senior Manager of Clinical Data Analytics, Dr. Raimann conducts epidemiological research in dialysis and oversees many analytical projects. He has first- and co-authored numerous also serves as Associate Editor of the journals ‘Trials’ and “Scientific Reports”...

Hanjie Zhang, MSc, PhD

Supervisor of Biostatistics and Applied Artificial Intelligence /Machine Learning

Hanjie joined the RRI in 2014. She received a Master’s Degree in statistics from Columbia University, New York and a PhD in Medical Science from the University of Maastricht, The Netherlands. Hanjie has been involved in the design of several large cluster-randomized clinical trials and complex statistical analyses in collaboration with the Medical Office, FMCNA...

Stephan Thijssen, M.D.

Vice President, Applied and Basic Research

Prior to coming to New York, Dr. Thijssen worked in the Nephrology Department at the University Hospital Homburg, Germany. He joined Renal Research Institute in 2005 and currently serves as VP of Applied and Basic Research. Dr. Thijssen brings more than one and a half decades of research experience to the RRI team, covering laboratory research, clinical research, epidemiology research and mathematical modeling...