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

Authors

Xixi Zhao
Tara I Chang
Wolfgang C Winkelmayer
Jin Long
Sai Liu
Olivera Marsenic

Publication Date

2-1-2024

Journal

Kidney Medicine

DOI

10.1016/j.xkme.2023.100773

PMID

38317757

PMCID

PMC10839769

PubMedCentral® Posted Date

12-9-2023

PubMedCentral® Full Text Version

Post-print

Published Open-Access

no

Keywords

Children, adolescents, young adults, pediatric, intradialytic hypotension, hemodialysis, mortality, death, survival analysis

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 (agedyears) and predialysis systolic blood pressure (150 mm Hg). We also examined IDH as occurring in50% of baseline treatments, and did not find a dose-response association with mortality (

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.

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