Abstract: FR-PO0488
Ultrafiltration Thresholds Associated with Intradialytic Hypotension in Children Receiving Maintenance Hemodialysis
Session Information
- Dialysis: Hemodiafiltration, Ultrafiltration, Profiling, and Interdialytic Symptoms
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
- Thadani, Sameer, Baylor College of Medicine, Houston, Texas, United States
- Silos, Christin N., Baylor College of Medicine, Houston, Texas, United States
- Vega, Molly RW, Baylor College of Medicine, Houston, Texas, United States
- Brokenshire, Samantha, Texas Children's Hospital, Houston, Texas, United States
- Geer, Jessica, Texas Children's Hospital, Houston, Texas, United States
- Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
- Srivaths, Poyyapakkam, Baylor College of Medicine, Houston, Texas, United States
Background
In adults on maintenance hemodialysis (iHD), ultrafiltration rates (UFR) exceeding 13 ml/kg/hr have been linked to poor outcomes. This threshold is often applied to pediatric patients, although the cardiovascular physiology and comorbid profiles of children differ significantly. The appropriateness of this adult-derived cut-off in children remains unclear. We aimed to identify UFR thresholds associated with intradialytic hypotension (IDH) in children receiving maintenance iHD.
Methods
We performed a single-center retrospective study of patients <18 years who underwent maintenance iHD at Texas Children’s Hospital from January 2018 to January 2023. Patients who received iHD for acute indications were excluded. The primary exposure was average UFR, defined as total UF divided by dialysis duration and index to weight (ml/kg/hr). Hemodynamic and treatment data were collected every 15 minutes per unit protocol. IDH was defined using the pediatric advanced life support criteria. We used receiver operating characteristic curves to identify average UFR cutoffs that best predicted IDH.
Results
We analyzed 20,432 iHD treatments across 133 patients, totaling 4,575,871 minutes. Median age was 13 years (IQR 8–16), and 39% of sessions were in female patients. Median pre-iHD weight was 36 kg (IQR 23–50); 86% of sessions used a dual-lumen catheter. IDH occurred in 2,158 treatments (11%), with a median onset of 127 minutes (IQR 70–179). Across all weights, an average UFR >14.12 ml/kg/hr showed moderate predictive ability for IDH (AUROC 0.69). Stratification by weight
For patients <10 kg, average UFR >9.15 ml/kg/hr (AUROC 0.70)
For patients 10–20 kg, average UFR >15.40 ml/kg/hr (AUROC 0.72)
For patients >20 kg, average UFR >13.85 ml/kg/hr (AUROC 0.69)
Conclusion
Without controlling for other covariates, an average UFR >14.12 ml/kg/hr moderately predicted IDH in children receiving maintenance iHD. However, weight-based variation in optimal cutoffs suggests that a single threshold may not be appropriate for all pediatric patients. Additionally, the PALS criteria for hypotension is a conservative definition, and IDH is a late marker of hemodynamic instability; therefore, future studies should further investigate optimal UFR thresholds in children receiving maintenance iHD.