Abstract
BackgroundVascular calcification is associated with structural and functional abnormality of the heart and blood vessels. We investigated the relationship between intradialytic hypotension (IDH) and vascular calcification in hemodialysis (HD) patients, and their impacts on cardiovascular events (CVEs).MethodWe enrolled 191 maintenance HD patients who underwent plain abdomen radiography for abdominal aortic calcification score (AACS). A nadir systolic blood pressure (BP) < 90 mm Hg or the requirement of bolus fluid administration was required to quantify the hypotension diagnosis. IDH was defined as > 2 hypotension episodes during 10 HD treatments.ResultsAmong the 191 patients, IDH occurred in 32. AACS was higher in the IDH group compared with the no-IDH group (8.4 ± 6.0 vs. 4.9 ± 5.2, respectively; P = 0.001). High AACS was an independent risk factor after adjustment for age, diabetes mellitus, ultrafiltration, diastolic BP, and calcium level (odds ratio (OR) = 1.09, 95% CI = 1.01–1.18; P = 0.03). Patients with both IDH and AACS ≧ 4 had the highest cumulative CVE rate (27.9%, P = 0.008) compared with 11.2%, 12.5%, and 6% for those with AACS ≧ 4 only, with IDH only, and neither, respectively. In multivariate analysis, the presence of both IDH and AACS ≧ 4 was a significant predictor of CVE (hazard ratio (HR) = 2.84, 95% CI = 1.04–7.74, P = 0.04).ConclusionIDH is associated with abdominal aortic calcification and is an independent risk factor for IDH. Both IDH and high AACS were significant predictors of CVE.
Highlights
Intradialytic hypotension (IDH) is a common complication during hemodialysis (HD)
intradialytic hypotension (IDH) is associated with abdominal aortic calcification and is an independent risk factor for IDH
The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) defines IDH as “a decrease in systolic blood pressure (BP) by ! 20 mm Hg or a decrease in MAP [mean arterial pressure] by 10 mm Hg associated with symptoms that include: abdominal discomfort; yawning; sighing; nausea; vomiting; muscle cramps; restlessness; dizziness or fainting; and anxiety” [1]
Summary
Intradialytic hypotension (IDH) is a common complication during hemodialysis (HD). The National Kidney Foundation Kidney Disease Outcomes Quality Initiative (KDOQI) defines IDH as “a decrease in systolic BP by ! 20 mm Hg or a decrease in MAP [mean arterial pressure] by 10 mm Hg associated with symptoms that include: abdominal discomfort; yawning; sighing; nausea; vomiting; muscle cramps; restlessness; dizziness or fainting; and anxiety” [1]. IDH continues to be a leading problem, especially in the cardiovascularly compromised patients. This predominance can be explained by the fact that structural and functional abnormalities of the heart and blood vessels increase patient sensitivity to changes in fluid status [3]. Vascular calcification is common in end-stage renal disease and is associated with cardiac changes [4]. It induces stiffening of the vessel wall and reduces vascular compliance, which has been found to predict cardiovascular mortality. We investigated the relationship between intradialytic hypotension (IDH) and vascular calcification in hemodialysis (HD) patients, and their impacts on cardiovascular events (CVEs)
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