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. 2021 Dec;43(1):40-48.
doi: 10.1080/0886022X.2020.1853570.

High ultrafiltration rate induced intradialytic hypotension is a predictor for cardiac remodeling: a 5-year cohort study

Jinbo Yu  1   2   3 , Xiaohong Chen  1   3 , Yang Li  1   3 , Yaqiong Wang  1   3 , Zhonghua Liu  1   3 , Bo Shen  1   3 , Jie Teng  1   3 , Jianzhou Zou  1   3 , Xiaoqiang Ding  1   3
Affiliations

High ultrafiltration rate induced intradialytic hypotension is a predictor for cardiac remodeling: a 5-year cohort study

Jinbo Yu et al. Ren Fail. 2021 Dec.

Abstract

Background: Intradialytic-hypotension (IDH) is a common complication of hemodialysis. High ultrafiltration rate (UFR) might lead to IDH. However, the relationships between UFR, IDH, and cardiac remodeling among hemodialysis patients in the long-term have not been deeply explored.

Methods: This retrospective cohort study collected clinical and echocardiographic data. Patients were enrolled from 1 January 2014 to 31 March 2014 and were followed-up for 5-year. Those who suffered from more than four hypotensive events during three months (10% of dialysis treatments) were defined as the IDH group. Subgroup analysis was done according to the UFR of 10 ml/h/kg. Associations between UFR, IDH, and alterations of cardiac structure/function were analyzed.

Results: Among 209 patients, 96 were identified with IDH (45.9%). The survival rate of IDH patients was lower than that of no-IDH patients (65.5% vs. 81.4%, p = .005). In IDH group, decreased ejection fraction (EF), larger left atrium diameter index (LADI), and left ventricular mass index (LVMI) (p < .05) were observed at the end of the follow-up. In multivariate logistic model, the interaction between UFR and IDH was notably associated with LVMI variation (OR = 1.37). After adjusting covariates, UFR was still an independent risk factor of LVMI variation (OR = 1.52) in IDH group. In subsequent analysis, we divided patients according to UFR 10 ml/h/kg. For IDH-prone patients, decreased EF, larger LADI, and LVMI (p < .05) were observed at the end of the study only in high-UFR group.

Conclusions: UFR and IDH have interactions on cardiac remodeling. High ultrafiltration rate induced IDH is a predictor for cardiac remodeling in long-term follow-up.

Keywords: Intradialytic hypotension; cardiac remodeling; hemodialysis; left ventricular mass index; ultrafiltration rate.

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Conflict of interest statement

None of the authors has any competing interests to declare, financial or otherwise.

Figures

Figure 1.
Figure 1.
Kaplan–Meier survival curves of patients with IDH and no-IDH.
See this image and copyright information in PMC

Comment in

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