Abstract: FR-PO0425
Burden of Intradialytic Hypotension in Acute Dialysis in Pediatric Patients
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
- Thadani, Sameer, Baylor College of Medicine, Houston, Texas, United States
- Dolan, Kristin J., Baylor College of Medicine, Houston, Texas, United States
- Silos, Christin N., Baylor College of Medicine, Houston, Texas, United States
- Maffei, Salvador R, Baylor College of Medicine, Houston, Texas, United States
- Srivaths, Poyyapakkam, Baylor College of Medicine, Houston, Texas, United States
- Akcan Arikan, Ayse, Baylor College of Medicine, Houston, Texas, United States
Background
Intradialytic hypotension (IDH) is a known complication of hemodialysis and has been associated with poor outcomes in adults. IDH can lead to decreased end-organ perfusion, dialytrauma, and impaired renal recovery; therefore, mitigating IDH in patients receiving acute hemodialysis has the potential to improve clinical outcomes. In children receiving acute hemodialysis, little is known about the prevalence of this adverse event, and children may be at increased risk for poor long-term outcomes due to their developing cardiovascular and renal systems. In this study, we aim to investigate the prevalence of IDH in children receiving acute hemodialysis.
Methods
We conducted a single-center retrospective cohort study of patients under 18 years of age who underwent acute intermittent hemodialysis at Texas Children’s Hospital between January 2014 and January 2025. IDH was defined using age-based criteria from the Pediatric Advanced Life Support (PALS) guidelines, which specify systolic blood pressure thresholds consistent with hypotension across varying pediatric age groups. Hemodynamic parameters were systematically collected at 15-minute intervals during each dialysis session in accordance with the institution’s standard monitoring protocol.
Results
A total of 468 pediatric patients underwent 30,467 acute hemodialysis treatments during the study period. The median patient age was 14 years (1–17), and 19,691 (65%) of the treatments were prescribed for male patients. At the initiation of dialysis, the median systolic blood pressure was 111 mmHg (100–122), and the median diastolic blood pressure was 67 mmHg (57–78). Overall, 5,510 treatments (16%) met the PALS criteria for IDH.
Conclusion
Utilizing PALS criteria to define IDH, we found that approximately 1 in 7 acute hemodialysis treatments in children are complicated by IDH. This prevalence is similar to what has been reported in pediatric patients receiving maintenance hemodialysis. Given the well-documented adverse outcomes associated with IDH in adults, further studies are needed to identify modifiable factors such as ultrafiltration rates and treatment frequency that could be targeted to reduce morbidity and mortality in this vulnerable population.