Kidney Week

Abstract: TH-OR147

Intradialytic Hypotension and Incident Peripheral Artery Disease in Patients with ESKD on Hemodialysis

Session Information

• Vascular Access and Complications of Hemodialysis
  November 07, 2019 | Location: 201, Walter E. Washington Convention Center
  Abstract Time: 06:18 PM - 06:30 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Seong, Eun Young, Pusan National University Hospital, Busan, Korea (the Republic of)

Eun Young Seong, MD, PhD



Residency: Pusan National University Hospital, Busan, South Korea, Internal Medicine Residency (1999) Fellowship: Seoul National University Hospital, Division of Nephrology, Seoul, South Korea (2004) Board Certification: Nephrology, Korean Board of Internal Medicine Medical Education: Pusan National University School of Medicine, Busan, South Korea (2008), PhD Academic Appointments: Associate Professor, Pusan National University School of Medicine

• Liu, Sai, Stanford University School of Medicine, Palo Alto, California, United States

Sai Liu,

• Song, Sang Heon, Pusan National University Hospital, Busan, Korea (the Republic of)

Sang Heon Song,

• Leeper, Nicholas J., Stanford University School of Medicine, Palo Alto, California, United States

Nicholas J. Leeper,

• Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States

Wolfgang C. Winkelmayer,

• Montez-Rath, Maria E., Stanford University School of Medicine, Palo Alto, California, United States

Maria E. Montez-Rath,

• Chang, Tara I., Stanford University School of Medicine, Palo Alto, California, United States

Tara I. Chang,

Background

Intradialytic hypotension (IDH) may decrease systemic circulation to the lower extremities, exacerbating symptoms of peripheral artery disease (PAD). We sought to evaluate the relationship between IDH and incident PAD among patients on hemodialysis (HD).

Methods

Using the data from USRDS linked to a large dialysis provider, we identified adults without pre-existing PAD who initiated HD between 2006-2011. Exposure: time-varying proportion of HD sessions with IDH, defined as nadir systolic blood pressure <90 mmHg, categorized as 0%, 1-14%, 15-29%, and ≥30% in 30-day intervals. Outcome: incident PAD, ascertained using PAD diagnosis codes or procedure codes for amputation or revascularization, in the subsequent 30-day interval. We estimated unadjusted and adjusted sub-distribution hazard ratios using Fine and Gray models with time specified in the counting-process style, assuming death and kidney transplant as competing events. Models were stratified by incident HD year and adjusted for baseline characteristics, comorbidities, healthcare use and laboratory values. Missing data were handled using multiple imputation by chained equations as implemented in R.

Results

In our cohort (N=45,489), patients with a more frequent IDH were more often women and of white race, and had a higher prevalence of diabetes, coronary artery diseases and heart failure. During 61,842 person-years of follow-up, 8,111 patients had incident PAD. We found a graded, direct association of IDH with incident PAD. For example, the presence of IDH in ≥30% of dialysis sessions was associated with an adjusted 36% increase in the hazard of incident PAD (95% CI, 27%-45%) compared to 0% IDH, in patients without PAD or who have experienced the competing events (Figure 1).

Conclusion

Patients with ESKD on HD with more frequent IDH have a higher hazard of incident PAD in the subsequent 30 days. Patients with more frequent IDH may warrant a careful examination for PAD such as foot examinations or other diagnostic testing.

Funding

• Government Support - Non-U.S.