Intradialytic Hypotension and Mortality in Adolescents and Young Adults With Kidney Failure Receiving Maintenance Hemodialysis

Abstract

Rationale & objective: Intradialytic hypotension (IDH) is associated with mortality in adults with kidney failure requiring hemodialysis (HD); however, large-scale pediatric studies are lacking. Moreover, there is no evidence-based consensus definition of IDH in pediatric literature. We aimed to examine the association of commonly used definitions of IDH with mortality in adolescents and young adults.

Study design: This was a retrospective observational cohort study.

Setting & participants: In total, 1,199 adolescents and young adults (N = 320, aged 10-18 years and N = 879, aged 19-21 years) who initiated HD in a large dialysis organization were included.

Exposures: This study used different definitions of IDH.

Outcome: The study outcome was 2-year all-cause mortality.

Analytical approach: Several definitions of IDH were selected a priori based on a literature review. Patients were classified as having IDH if it was present in at least 30% of HD treatments during the first 90 days after dialysis initiation. Cox proportional hazards regression was used to test whether IDH associated with 2-year all-cause mortality.

Results: Over a 2-year follow-up period, 54 (4.5%) patients died. Dependent on its definition, IDH was present in 2.9%-61.1% of patients. After the multivariable adjustment for sociodemographic and clinical characteristics, we found no association of IDH with mortality. Results were consistent across subgroups stratified by age (aged <18 and 19-21 years) and predialysis systolic blood pressure (<120, 120-150, and >150 mm Hg). We also examined IDH as occurring in <5%, 5%-29%, 30%-50%, and >50% of baseline treatments, and did not find a dose-response association with mortality (P > 0.05).

Limitations: Owing to low event rates, our current sample size may have been too small to detect a difference in mortality.

Conclusions: Our study found that IDH was not associated with mortality in adolescents and young adults.

Keywords: Children; adolescents; death; hemodialysis; intradialytic hypotension; mortality; pediatric; survival analysis; young adults.

Figure 1

A flow diagram of cohort selection. BP, blood pressure; HD, hemodialysis.

Figure 2

The frequency of IDH for the selected IDH definitions. Frequency is defined by the number of dialysis sessions meeting the specified IDH definition divided by the total number of dialysis sessions during the baseline period. IDH, intradialytic hypotension.

Figure 3

Adjusted survival curves. Compound definitions of SBP < 90 mm Hg + 20 drop and SBP < 90 mm Hg + 30 drop were excluded from the analysis owing to an inadequate number of events in the IDH group to produce a reliable prediction model. All analyses were adjusted for age, sex, race, and cause of kidney failure. IDH, intradialytic hypotension; SBP, systolic blood pressure.

Figure 4

Analyses using categories of IDH episode frequency. Analyses were adjusted for age, sex, race, and cause of kidney failure. IDH, intradialytic hypotension.