Comparison of dialysis and clinical characteristics of patients with frequent and occasional hemodialysis-associated hypotension.
BACKGROUND
Symptomatic dialysis hypotension (DH) continues to be a common problem. By comparing patients prone and resistant to DH, several dialysis session and patient related characteristics have been identified that confer susceptibility to DH. Less is known, however, about the comparison of patients with frequent and only occasional DH. The aim of the study was to compare clinical and dialysis-session- (complicated by hypotension) related data between those with frequent (fDH) and those with occasional dialysis hypotension (oDH).


METHODS
Nine hundred and fifty-eight patients at 11 dialysis units were followed for 10 months and characteristics of patients with fDH (> or = 10 hypotensive events necessitating medical intervention) (n = 96) were compared to that of patients with oDH (1 or 2 events/10 months) (n = 130). Significant and independent predictors of fDH were obtained by multivariate logistic regression.


RESULTS
Significant differences between fDH vs. oDH patients were older age (64.4 vs. 56.9 years, p < 0.001), more females (66 vs. 46%, p < 0.005) in fDH. More fDH patients had diabetes (27 vs. 15%, p < 0.05) and less had glomerulonephritis (15 vs. 35%, p < 0.001) as the cause for ESRD. Coronary artery disease (68 vs. 50%, p < 0.01) and long-acting nitrate treatment (51 vs. 30%, p < 0.001) was more frequent while treatment with ACEI (33 vs. 48%, p < 0.05) or Ca-channel blockers (40 vs. 53%, p < 0.05) were less frequent in patients with fDH. Patients with fDH had higher serum phosphorus levels (1.99 vs. 1.79 mmol, p < 0.005). Dialysis session related data were similar but the hypotensive episode occurred earlier during dialysis in fDH (136 vs. 156 min, p < 0.01). In multivariate analysis, significant independent predictors of fDH were older age (OR = 1.04 [1.02-1.07]), lack of glomerulonephritis as renal diagnosis (2.63 [1.18-5.87]), high phosphorus levels (5.0 [2.45-10.0]), lack of use of Ca-channel blockers (2.09 [1.12-3.91]), and the use of nitrates (2.38 [1.24-4.55]).


CONCLUSIONS
Features of the dialysis sessions complicated by DH seem to be similar between patients with fDH and oDH, while patient characteristics such as older age, renal diagnosis other than glomerulonephritis, higher serum phosphorus levels, use of nitrates, and lack of use of calcium channel blockers are significantly and independently associated with fDH.
Tislér
András
A
Eurocare Nephrological Network, and 1st Department of Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary. atisler@mail.matav.hu
Akócsi
Katalin
K
Hárshegyi
Ibolya
I
Varga
Gábor
G
Ferenczi
Sándor
S
Grosz
Mária
M
Kulcsár
Imre
I
Löcsey
Lajos
L
Sámik
József
J
Solt
István
I
Szegedi
János
J
Tóth
Eszter
E
Wágner
Gyula
G
Kiss
István
I
D000367:Age Factors; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002121:Calcium Channel Blockers / Q000627:therapeutic use; D016022:Case-Control Studies; D003327:Coronary Disease / Q000150:complications; D048909:Diabetes Complications; D005260:Female; D005921:Glomerulonephritis / Q000150:complications / Q000453:epidemiology; D006801:Humans; D007022:Hypotension / Q000150:complications / Q000453:epidemiology* / Q000209:etiology; D007676:Kidney Failure, Chronic / Q000209:etiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010758:Phosphorus / Q000097:blood; D006435:Renal Dialysis / Q000009:adverse effects*
D000806:Angiotensin-Converting Enzyme Inhibitors; D000959:Antihypertensive Agents; D002121:Calcium Channel Blockers; D010758:Phosphorus