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

Abstract

Rationale & ObjectiveIntradialytic hypotension is associated with mortality in adults with kidney failure requiring hemodialysis; however, large-scale pediatric studies are lacking. Moreover, there is no evidence-based consensus definition of intradialytic hypotension in the pediatric literature. We aimed to examine the association of commonly used definitions of intradialytic hypotension with mortality in adolescents and young adults. Study DesignRetrospective observational cohort study. Setting& Participants: 1,199 adolescents and young adults (n=320, ages 10-18 years and n= 879, ages 19-21 years) who initiated hemodialysis at a large dialysis organization. ExposuresDifferent definitions of intradialytic hypotension. Outcome2-year all-cause mortality. Analytical ApproachSeveral definitions of intradialytic hypotension were selected a priori based on a literature review. Patients were classified as having intradialytic hypotension if it was present in at least 30% of hemodialysis treatments during the first 90 days after dialysis initiation. Cox proportional hazards regression was used to test whether intradialytic hypotension associated with 2-year all-cause mortality. ResultsOver a 2 year follow up period, 54 (4.5%) patients died. Dependent on its definition, intradialytic hypotension was present in 2.9% to 61.1% of patients. After multivariable adjustment for sociodemographic and clinical characteristics, we found no association of intradialytic hypotension with mortality. Results were consistent across subgroups stratified by age (<18 and 19-21 years old) and pre-dialysis systolic blood pressure (<120, 120-150, >150 mmHg). We also examined intradialytic hypotension as occurring in <5%, 5-29%, 30-50%, and >50% of baseline treatments, and did not find a dose-response association with mortality (p value > 0.05). LimitationsDue to low event rates, our current sample size may have been too small to detect a difference in mortality. ConclusionsOur study found that intradialytic hypotension was not associated with mortality in adolescents and young adults.