Abstract: SA-PO1091
Effect of Modified Hemodialysis Orders with Central BP Monitoring on Intradialytic Hypotension
Session Information
- Kidney Replacement Therapy and Care Delivery Innovations
October 24, 2026 | Location: Exhibit Hall A, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Morrow, Alexandra, Ochsner Medical Center, New Orleans, Louisiana, United States
- Olsen, Sarah A., Ochsner Medical Center, New Orleans, Louisiana, United States
- Alsaid, Jafar, Ochsner Medical Center, New Orleans, Louisiana, United States
Background
Intradialytic hypotension (IDH) is a major contributor to cardiovascular morbidity in hemodialysis patients. We evaluated whether modified hemodialysis orders (MHDO), individualized according to peripheral and central blood pressure (BP), volume status and metabolic profile, reduce the incidence of IDH compared with standard hemodialysis (HD) care.
Methods
Prospective single-center controlled interventional study started in 2024. It included hemodialysis ESRD inpatients that are admitted for reasons other than access failure, decompensated heart failure, acute coronary syndrome, acute stroke, shock, or hypertensive crises. MHDO incorporated individualized adjustments to dialysate sodium, potassium, bicarbonate, calcium, temperature, and ultrafiltration rate based on the peripheral BP, volume status, and metabolic profile. The central and peripheral BP were measured every 15 minutes during the session with SphygmoCor AtCore system. IDH was defined as a drop of more than ≥20 mmHg in systolic and/or ≥10 mmHg in diastolic. The incidence of hypotensive episodes was compared between MHDO and standard care sessions.
Results
Thirty-two patients were included through 85 dialysis sessions with 1364 BP readings. Mean age 54.8±15 years, males were 60%. Mean BMI 29±6.7 kg/sqm. Comorbidities included HTN (100%), DM (73%), CAD (38%), and CHF (57%).
IDH occurred in 24% of BP readings in the MHDO arm (200/831) versus 32% in standard care (165/520), P=0.002, corresponding to a 25% relative risk reduction. Systolic, diastolic, and MAP values were significantly higher with MHDO compared with standard care (SBP 142±21.7 vs 138±25.2 mmHg, P=0.001; DBP 76±13.7 vs 72±11.1 mmHg, P<0.001; MAP 98±15 vs 94±14.2 mmHg, P<0.001). Pulse pressure was similar (~65 mmHg).
Patients experiencing IDH had significantly lower peripheral and central BP across all parameters (all P<0.001), confirming physiologic concordance between central and peripheral BP changes.
Conclusion
MHDO guided by frequent central and peripheral BP monitoring resulted in a 25% reduction in intradialytic hypotension and maintained higher systolic, diastolic, and MAP values compared with standard HD care. Further studies are required to test the individualized MHDO on major cardiovascular events in ESRD patients.
Acknowledgment
Hemodialysis unit nursing team in Ochsner Medical Center