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Abstract: TH-PO293

Predialysis Serum Albumin and Hemoglobin and the Risk of Intradialytic Hypotension

Session Information

Category: Dialysis

  • 801 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Curtis, Katherine, Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States
  • Waikar, Sushrut S., Boston Medical Center, Boston, Massachusetts, United States
  • McCausland, Finnian R., Brigham and Women's Hospital Department of Medicine, Boston, Massachusetts, United States

Group or Team Name

  • McCausland Lab.
Background

Intravascular hypovolemia may predispose to intra-dialytic hypotension (IDH), a common occurrence among patients receiving maintenance hemodialysis (HD), which is associated with adverse outcomes. Whether higher pre-HD serum albumin and hemoglobin (Hb), which may reflect hemoconcentration, could serve as biomarkers to predict IDH during an HD session warrants further investigation.

Methods

We analyzed data from a prospective cohort study of patients included in the DaVita Biorepository (N=950). Pre-HD serum albumin, hemoglobin, and complete blood pressure (BP) data were available for n=938 patients and n=11,460 sessions. Random-effects Poisson regression models (adjusting for age, sex, race, access type, pre-HD systolic BP (SBP), session length, ultrafiltration, post-HD weight, diabetes mellitus, heart failure, ischemic heart disease, peripheral vascular disease, lung disease) were fit to examine the association of serum albumin and hemoglobin with IDH (defined as minimum SBP <100 if pre-SBP ≥160 or minimum SBP <90 if pre-SBP<160 mmHg).

Results

At baseline, mean age was 58 ±14 years and 44% were female. The mean pre-HD albumin and hemoglobin were 3.5 ±0.5 g/dL and 10.8 ±1.6 g/dL, respectively. A total of 1,606 (14%) sessions were complicated by IDH. Higher pre-HD serum albumin was associated with a 17% higher adjusted risk of IDH (IRR 1.17; 95%CI 1.00, 1.37). Higher Hb (per g/dL) was associated with 6% higher risk of IDH (IRR 1.06; 95%CI 1.02,1.11). When both were considered in the same model, only hemoglobin retained significance (IRR 1.05; 95%CI 1.01, 1.10).

Conclusion

Higher pre-HD serum albumin and hemoglobin were each independently associated with IDH, but only hemoglobin retained significance in a joint-model. Higher hemoglobin may thus serve as a widely-available biomarker to predict IDH at an individual HD-session level.