Abstract: FR-PO0426
Intradialytic Hypotension Associated with Noncardiovascular Mortality in Patients on Hemodialysis
Session Information
- Dialysis: Measuring and Managing Symptoms and Syndromes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Takenaka, Yuto, Mitsui Kinen Byoin, Chiyoda, Tokyo, Japan
- Hashiba, Toyohiro, Mitsui Kinen Byoin, Chiyoda, Tokyo, Japan
- Masaki, Kazunobu, Shinkoiwa Clinic, Katsushika-ku, Tokyo, Japan
- Mise, Naobumi, Mitsui Kinen Byoin, Chiyoda, Tokyo, Japan
Background
As hemodialysis (HD) patients age, the distribution of causes of death in HD patients is changing. The aim of this study is to re-evaluate the impact of intradialytic hypotension (IDH) on their prognosis.
Methods
This single-center retrospective cohort study included 228 maintenance HD patients. We recorded IDH episodes in 12 consecutive sessions from February 2014 and divided the patients into 2 groups: those with ≥ 1 IDH episode into IDH Group (n = 111) and those without into Non-IDH Group (n = 117). IDH was defined as a symptomatic systolic blood pressure drop ≥30 mmHg or requiring intervention. The primary outcomes were all-cause, cardiovascular death (CVD), and non-CVD mortality. Participants were followed until death, kidney transplantation, loss to follow-up, or 31 December 2021. Cox proportional hazards analyses were performed for these outcomes and Fine-Gray competing risk regression was used for CVD and non-CVD mortality.
Results
During follow-up of median 5.7 years, 91 patients (40%) died. All-cause mortality was significantly higher in IDH Group than in Non-IDH Group (51 % vs. 29 %, respectively, p < 0.01). CVD mortality did not differ between the 2 groups (16 % vs. 15 %, respectively, p = 1.00), whereas non-CVD mortality was significantly higher in IDH Group than in Non-IDH Group (35% vs. 14%, respectively, p < 0.01). Multivariate Cox models identified IDH as an independent risk factor for all-cause mortality (adjusted HR 1.98, 95% CI 1.28–3.06, p < 0.01) and non-CVD mortality (adjusted HR 2.83, 95% CI 1.54–5.18, p < 0.01), but not for CVD mortality (adjusted HR 1.28, 95% CI 0.65–2.52, p = 0.47). Fine-Gray models corroborated these findings, demonstrating a significant association between IDH and non-CVD mortality (adjusted sub-HR 2.63, 95% CI 1.39–4.99, p < 0.01). Among deaths in IDH Group, 68% were due to non-CVD causes, with infections (33%) being the most frequent. Patients with IDH also exhibited lower serum albumin levels (3.4 vs. 3.6 g/dL, respectively, p < 0.01) and higher C-reactive protein levels (0.2 vs. 0.1 mg/dL, respectively, p = 0.04), indicating malnutrition and systemic inflammation.
Conclusion
IDH was independently associated with non-CVD mortality and may reflect underlying frailty in the aging HD population.