The relationship between hypoalbuminemia and intradialytic hypotention in hemodialysis patients

Abstract

Objective The aim of this study was to evaluate the relationship between serum albumin and intradialytic hypotension (IDH). Background Hypoalbuminemia and IDH are common complications during hemodialysis (HD) session. Hypotension is a risk factor for mortality and morbidity in HD patients. Patients and methods We conducted a cross-sectional study on 50 patients with end-stage renal disease who received regular HD session three times weekly for more than 3 months (from April to July 2017) at Ashmoun General Hospital. They were divided into two groups: group 1 included patients who developed recurrent attacks of IDH (24 patients) and group 2 included patients who did not develop IDH (26 patients). Data collected from each patient included the following: (i) demographic features and clinical features (blood pressure (BP) changes during session, ultrafiltration rate, intradialytic weight gain, duration of dialysis, cause of end-stage renal disease, surface area of dialyzer, and blood flow of the machine); (ii) blood chemistry (creatinine level, urea, hemoglobin, hematocrit value, albumin, triglycerides, cholesterol, aspartate aminotransferase, alanine aminotransferase, Na*, K*, and KT/V); (iii) echocardiographic assessment of left ventricular geometry; and (iv) inferior vena cava-guided ultrasonography. Results Serum albumin level among group I ranged between 2.4 and 4.7 mg/dl, with mean ± SD of 3.1 + 0.53 mg/dl, whereas in group II, serum albumin level ranged between 2.6 and 4.6 mg/dl with mean ± SD of 3.6 ± 0.48 mg/dl, with P value of 0.002, indicating there was a high significant difference between both groups. There was a highly significant positive correlation between delta systolic BP and IVC collapsibility index (IVCC). There was a highly significant negative correlation between serum albumin and IVCC, and there was a highly significant negative correlation between delta systolic BP and IVC diameter. Conclusion We concluded that serum albumin is a parameter that is associated with IDH and found that bedside measurements of IVCC and IVC diameter are easy and good markers for prediction of IDH.