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. 2019 Dec 19;20(1):473.
doi: 10.1186/s12882-019-1662-x.

Intradialytic hypotension is an important risk factor for critical limb ischemia in patients on hemodialysis

Ryo Matsuura  1   2 , Sumi Hidaka  3 , Takayasu Ohtake  1 , Yasuhiro Mochida  1 , Kunihiro Ishioka  1 , Kyoko Maesato  1 , Machiko Oka  1 , Hidekazu Moriya  1 , Shuzo Kobayashi  1
Affiliations

Intradialytic hypotension is an important risk factor for critical limb ischemia in patients on hemodialysis

Ryo Matsuura et al. BMC Nephrol. .

Abstract

Background: Critical limb ischemia (CLI) and intradialytic hypotension (IDH) are common complications in patients on hemodialysis (HD). However, limited data are available on whether IDH is related to CLI in these patients. The aim of this retrospective study was to evaluate whether IDH is a risk factor for CLI in HD patients.

Methods: We examined the frequency of IDH in 147 patients who received HD between January 1 and June 30, 2012. Blood pressure was measured during HD every 30 min and IDH was defined as a ≥ 20 mmHg fall in systolic blood pressure compared to 30 min before and a nadir intradialytic systolic blood pressure < 90 mmHg. The primary study outcome was newly developed CLI requiring revascularization treatment or CLI-related death. We assessed the association of IDH with outcome using a multivariable subdistribution hazard model with adjustment for male, age, smoking and history of cardiovascular disease.

Results: The median follow-up period was 24.5 months. Fifty patients (34%) had episodes of IDH in the study entry period. During follow-up, 14 patients received endovascular treatment and CLI-related death occurred in 1 patient. Factors associated with incident CLI in univariate analysis were age, smoking, diabetes mellitus, peripheral arterial disease, history of cardiovascular disease, and IDH. IDH was significantly associated with the outcome with the subdistribution hazard ratio of 3.13 [95% confidence interval, 1.05-9.37].

Conclusions: IDH was an independent risk factor for incident CLI in patients on HD.

Keywords: Critical limb ischemia; Diabetes mellitus; Hemodialysis; Intradialytic hypotension; Risk factor.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Outline of study protocol. Abbreviations: CLI, critical limb ischemia; IDH, intradialytic hypotension
Fig. 2
Fig. 2
Flow of study participants. Abbreviation: CLI, critical limb ischemia; HD, hemodialysis
Fig. 3
Fig. 3
a Incidence of intervention for or death from CLI. Abbreviation: CLI, critical limb ischemia. b The estimation of the cumulative incidence function of CLI by history of IDH with death as a competing event. CLI, P = 0.01: Gray’s test. Abbreviations: CLI, critical limb ischemia; IDH, intradialytic hypotension. The number at risk of IDH(+) and IDH(−) groups are shown under the estimation of the cumulative icidence function of CLI
See this image and copyright information in PMC

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