Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Oct 8;13(10):1517-1525.
doi: 10.2215/CJN.13891217. Epub 2018 Sep 20.

The Relationship between Intradialytic Hypotension and Hospitalized Mesenteric Ischemia: A Case-Control Study

Affiliations

The Relationship between Intradialytic Hypotension and Hospitalized Mesenteric Ischemia: A Case-Control Study

Eun Young Seong et al. Clin J Am Soc Nephrol. .

Abstract

Background and objectives: Mesenteric ischemia is a rare but devastating condition caused by insufficient blood supply to meet the demands of intestinal metabolism. In patients with ESKD, it can be difficult to diagnose and has a >70% mortality rate. Patients on hemodialysis have a high prevalence of predisposing conditions for mesenteric ischemia, but the contribution of intradialytic hypotension, a potential modifiable risk factor, has not been well described.

Design, setting, participants, & measurements: We used data from the US Renal Data System to identify 626 patients on hemodialysis with a hospitalized mesenteric ischemia event (cases). We selected 2428 controls in up to a 1:4 ratio matched by age, sex, black race, incident dialysis year, diabetes mellitus, coronary artery disease, and peripheral artery disease. We used six different definitions of intradialytic hypotension on the basis of prior studies, and categorized patients as having had intradialytic hypotension if ≥30% of hemodialysis sessions in the 30 days before the event met the specified definition.

Results: The proportion of patients with intradialytic hypotension varied depending on its definition: from 19% to 92% of cases and 11% to 94% of controls. Cases had a higher adjusted odds (1.82; 95% confidence interval, 1.47 to 2.26) of having had intradialytic hypotension in the preceding 30 days than controls when using nadir-based intradialytic hypotension definitions such as nadir systolic BP <90 mm Hg. To examine a potential dose-response association of intradialytic hypotension with hospitalized mesenteric ischemia, we categorized patients by the proportion of hemodialysis sessions having intradialytic hypotension, defined using the Nadir90 definition (0%, 1%-9%, 10%-29%, 30%-49%, and ≥50%), and found a direct association of proportion of intradialytic hypotension with hospitalized mesenteric ischemia (P-trend<0.001).

Conclusions: Patients with hospitalized mesenteric ischemia had significantly higher odds of having had intradialytic hypotension in the preceding 30 days than controls, as defined by nadir-based definitions.

Keywords: Case-Control Studies; Kidney Failure, Chronic; Mesenteric Ischemia; Peripheral Arterial Disease; Prevalence; blood pressure; coronary artery disease; diabetes mellitus; end stage kidney disease; hemodialysis; hypotension; renal dialysis; risk factors; vascular disease.

PubMed Disclaimer

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Selection of patients on hemodialysis with hospitalized mesenteric ischemia (cases) and without hospitalized mesenteric ischemia (controls). We identified 626 cases and matched them in up to 1:4 ratio with 2428 controls matched for age, sex, race, calendar year of dialysis initiation, DM, CAD, and PAD. HD, hemodialysis; UF, ultrafiltration.
Figure 2.
Figure 2.
Percentage of patients on hemodialysis with hospitalized mesenteric ischemia (cases) and without hospitalized mesenteric ischemia (controls) with intradialytic hypotension, defined in six ways. The proportion of patients with intradialytic hypotension differed widely, depending on the definition used. Fall20, (predialysis SBP – nadir intradialytic SBP) ≥20 mm Hg; Fall30, (predialysis SBP – nadir intradialytic SBP) ≥30 mm Hg; Nadir90, nadir intradialytic SBP <90 mm Hg; Nadir100, nadir intradialytic SBP <100 mm Hg; Nadir90Fall20, nadir intradialytic SBP <90 mm Hg and (predialysis SBP – nadir intradialytic SBP) ≥20 mm Hg; Nadir90Fall30, nadir intradialytic SBP <90 mm Hg and (predialysis SBP – nadir intradialytic SBP) ≥30 mm Hg.
Figure 3.
Figure 3.
Odds of intradialytic hypotension (defined in six ways) among cases of hospitalized mesenteric ischemia and matched controls.Cases had a nearly two-fold higher odds of having had intradialytic hypotension in the 30 days before the index date compared with controls, when using a nadir-based IDH definition (i.e., Nadir90, Nadir100, Nadir90Fall20, and Nadir90Fall30). However, when using the two definitions that used the change in SBP (i.e., Fall20 and Fall30), there was no significant association of intradialytic hypotension and mesenteric ischemia. Adjustment for demographic and clinical factors did not significantly change the associations. Adjusted indicates adjusted for cause of ESKD, number of non-nephrology outpatient visits, hospital days, any nursing home stay, on the kidney transplant waiting list, all comorbidities, mean ultrafiltration rate, and central venous catheter use. 95% CI, 95% confidence interval; Fall20, (predialysis SBP – nadir intradialytic SBP) ≥20 mm Hg; Fall30, (predialysis SBP – nadir intradialytic SBP) ≥30 mm Hg; Nadir90, nadir intradialytic SBP <90 mm Hg; Nadir100, nadir intradialytic SBP <100 mm Hg; Nadir90Fall20, nadir intradialytic SBP <90 mm Hg and (predialysis SBP – nadir intradialytic SBP) ≥20 mm Hg; Nadir90Fall30, nadir intradialytic SBP <90 mm Hg and (predialysis SBP – nadir intradialytic SBP) ≥30 mm Hg.
Figure 4.
Figure 4.
Association (odds ratio and 95% confidence intervals) of proportion of intradialytic hypotension (defined as Nadir90) with hospitalized mesenteric ischemia. To examine a potential dose-response association of intradialytic hypotension with hospitalized mesenteric ischemia, we categorized patients by the proportion of hemodialysis sessions having intradialytic hypotension, defined using the Nadir90 definition and found a direct association of proportion of intradialytic hypotension with hospitalized mesenteric ischemia (P-trend<0.001). Adjusted indicates adjusted for cause of ESKD, number of non-nephrology outpatient visits, hospital days, any nursing home stay, on the kidney transplant waiting list, all comorbidities, mean ultrafiltration rate, and central venous catheter use. 95% CI, 95% confidence interval; HD, hemodialysis; Nadir90, nadir intradialytic SBP <90 mm Hg.

Comment in

References

    1. Clair DG, Beach JM: Mesenteric ischemia. N Engl J Med 374: 959–968, 2016 - PubMed
    1. Li SY, Chen YT, Chen TJ, Tsai LW, Yang WC, Chen TW: Mesenteric ischemia in patients with end-stage renal disease: A nationwide longitudinal study. Am J Nephrol 35: 491–497, 2012 - PubMed
    1. Bassilios N, Menoyo V, Berger A, Mamzer MF, Daniel F, Cluzel P, Buisson C, Martinez F: Mesenteric ischaemia in haemodialysis patients: A case/control study. Nephrol Dial Transplant 18: 911–917, 2003 - PubMed
    1. Bender JS, Ratner LE, Magnuson TH, Zenilman ME: Acute abdomen in the hemodialysis patient population. Surgery 117: 494–497, 1995 - PubMed
    1. Schoots IG, Koffeman GI, Legemate DA, Levi M, van Gulik TM: Systematic review of survival after acute mesenteric ischaemia according to disease aetiology. Br J Surg 91: 17–27, 2004 - PubMed

Publication types