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Kidney Week

Abstract: FR-PO791

Intra-Dialytic Syndrome and Time to Recovery in Patients on In-Center Hemodialysis

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD


  • Alvarez, Luis, Palo Alto Medical Foundation, Palo Alto, California, United States
  • Prichard, Sarah S., Outset Medical, San Jose, California, United States
  • Hu, Dean, Outset Medical, San Jose, California, United States
  • Chertow, Glenn Matthew, Stanford University School of Medicine, Palo Alto, California, United States

Patients on hemodialysis (HD) experience a variety of symptoms during dialysis described here as Intradialytic Syndrome (IDS). Patients also feel unwell for a period of time post HD. The purpose of this study was to assess frequency and severity of intradialytic symptoms and time to recovery post dialysis in a broad cross section of HD patients.


An online questionnaire was sent to patients in the National Kidney Foundation database via email. Patients included were adults on in-center hemodialysis 3 times/week for 3 or more months. Demographic and basic clinical data were obtained. A 12-item symptom questionnaire asked about the type and severity of symptoms during HD sessions in the previous week. Severity was rated on a 5-point Likert scale - 1 “not severe” to 5 “very severe”. It also asked how long it took to resume normal activities post dialysis, if they ever stopped dialysis early because of intradialytic symptoms, and for which symptoms they stopped.


5,000 e-mails were sent. 98 patients met the screening criteria and completed the questionnaire. Mean age 65±14 yrs, 39% female, 61% male, 65% White, 28% Black/African American, 46% diabetic, 35% history of coronary artery disease, and 87% with hypertension (100% on meds). 88% had intradialytic symptoms in the previous week, with a mean severity of 2.7 (range: 1 - 5).
The most common adverse events are shown in Table 1:

The median (10%, 90%) time to recovery and resume normal activities was 180 minutes (30 minutes, 13 hours). 35% reported having stopped dialysis early for symptoms. The most common symptom-related reasons to stop dialysis early were cramps and low blood pressure.


88% of a broad based sample of in-center HD patients reported having symptoms during dialysis. Because intradialytic syndrome can cause patients to terminate dialysis prematurely, innovation in dialysis should target reducing these symptoms.

Table 1
SymptomProportion of patents reporting intradialytic
symptoms in the past week
Fatique/feeling drained59%2.8
Low BP/hypotension41%2.1
Itchy skin20%2.0

*For patients reporting symptoms


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