Abstract
Intradialytic hypotension is a common problem during hemodialysis treatment. Despite several clinical variables have been authenticated for associations during dialysis session, the interaction effects between variables has not yet been presented. Our study aimed to investigate clinical factors associated with intradialytic hypotension by deep learning. A total of 279 participants with 780 hemodialysis sessions on an outpatient in a hospital-facilitated hemodialysis center were enrolled in March 2018. Associations between clinical factors and intradialytic hypotension were determined using linear regression method and deep neural network. A full-adjusted model indicated that intradialytic hypotension is positively associated with body mass index (Beta = 0.17, p = 0.028), hypertension comorbidity (Beta = 0.17, p = 0.008), and ultrafiltration amount (Beta = 0.31, p <; 0.001), and is inversely associated with the ultrafiltration rate in a hemodialysis session (Beta = -0.30, p = 0.001). The 4-factor locus obtained by the deep neural network reached the maximum performance metrics evaluation (accuracy = 64.97± 0.94; true positive rate = 87.97 ± 2.73; positive predictive value = 66.74 ± 0.98; Matthews correlation coefficient = 0.19 ± 0.03). The prediction model obtained by the deep learning scheme could be a potential tool for the management of intradialytic hypotension.
Highlights
Intradialytic hypotension (IDH) is not an uncommon event that occurs during a hemodialysis (HD) procedure
The univariate analysis indicated that IDH is positively correlated with the hypertension comorbidity (Beta =0.15, p =0.012) and serum calcium (Ca) level (Beta =0.13, p =0.033), and is inversely correlated with the cardiothoracic ratio (Beta = −0.13, p =0.032)
We found that leading factors associated with the occurrence of IDH during the HD were the UF amount (% dry weight), UF rate, and hypertension comorbidity
Summary
Intradialytic hypotension (IDH) is not an uncommon event that occurs during a hemodialysis (HD) procedure. The incidence is reported approximately 5% to 30% during HD treatment [1]–[4]. IDH is commonly defined as a decrease in the systolic blood pressure by ≥ 20 mmHg or in mean arterial pressure by ≥ 10 mmHg [5], [6]. The pathophysiological mechanisms of IDH are complex. Two components have been discussed since past few years. An imbalance the between central hypovolemia and the adequacy of hemodynamic responses. In end-stage kidney disease, patients commonly manifest autonomic and baroreceptor dysfunction and
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