Hypotension In Hemodialysis Patients Research Articles

Prediction models for intradialytic hypotension in hemodialysis patients: A protocol for systematic review and critical appraisal.

Intradialytic hypotension (IDH) is common in hemodialysis patients and can lead to several complications. Risk factors for IDH include demographic characteristics, comorbidities, dialysis procedure factors, and so on. Clinical studies on predictive models for dialysis-induced hypotension have shown inconsistent results. This systematic review aims to evaluate published prediction models for IDH, analyzing their characteristics, predictors, efficacy, and the methodological quality and applicability. The protocol has been prepared using the Preferred Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) guidelines. The systematic review protocol for IDH prediction in hemodialysis patients has been registered with the International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY2023110081, DOI: 10.37766/inplasy2023.11.0081). A comprehensive search across five major databases (PubMed, Web of Science, Cochrane Library, CNKI, and Wanfang) will be conducted for studies on prediction models of IDH among hemodialysis patients. Two researchers will independently screen literature, extract data, and evaluate the bias risk and applicability of included studies using prediction modelling study tools. This systematic review will provide critical insights into the efficacy and quality of reporting of the IDH model in hemodialysis patients. This will guide clinical staff in selecting the most appropriate IDH prediction model and inform future research endeavors in IDH prediction.

Artificial Intelligence and Machine Learning in Predicting Intradialytic Hypotension in Hemodialysis Patients: A Systematic Review.

Intradialytic hypotension (IDH) is a common and potentially life-threatening complication in hemodialysis patients. Traditional preventive measures have shown limited effectiveness in reducing IDH incidence. This systematic review evaluates the existing literature on the use of artificial intelligence (AI) and machine learning (ML) models for predicting IDH in hemodialysis patients. A comprehensive literature search identified five eligible studies employing diverse AI/ML algorithms, including artificial neural networks, decision trees, support vector machines, XGBoost, random forests, and LightGBM. These models utilized various features such as patient demographics, clinical data, laboratory findings, and dialysis-related parameters. The studies reported promising results, with several models achieving high prediction accuracies, sensitivities, specificities, and area under the receiver operating characteristic curve values for predicting IDH. However, limitations include variations in study populations, retrospective designs, and the need for prospective validation. Future research should focus on multicenter prospective studies, assessing clinical utility, and integrating interpretable AI/ML models into clinical decision support systems.

Correlation of Plasma Iron Profile and Intradialytic Hypotension in Hemodialysis Patients

Abstract: Intradialytic hypotension (IDH) has been a common complication which should be aware of, in hemodialysis procedure. Its pathogenesis is multifactorial, and severe anemia is considered as one of the most notable risk factors on IDH. This study aimed to evaluate the correlation between plasma iron profile and intradialytic hypotension in hemodialysis patients. This was an analytical and retrospective study using medical records of hemodialysis patients at Prof. Dr. R. D. Kandou Hospital, Manado from January to May 2022. Sampling was conducted through consecutive sampling method, on available records. Patients with CKD grade 5 which undergoes routine HD twice a week for >3 weeks, aged 18-60 years old were included, while subjects with sepsis, malignancy, autoimmune disease, crisis hypertension, and unstable congestive heart failure were excluded for further studies. The details on iron profile and blood pressure measurement were then extracted, which then analyzed with descriptive analysis and Pearson correlation using IBM SPSS Statistics 26.0. The results obtained a total of 35 patients; 57.1% were male. The Pearson correlation analysis on all variables reported several notable significant results, with a correlation between iron profile and blood pressure measurement were seen in TIBC and systole pre- and post-procedure (-.496 and -.611 respectively) with strong negative relationship; and serum ferritin value with systole post-procedure (.373) implying moderate positive relationship. The results suggested that the increase of ferritin value and decrease of TIBC value were correlated with the increase of systole blood pressure. Meanwhile, the TIBC had a strong positive correlation with systolic changes (.473) meanwhile serum iron had a moderate negative correlation with diastolic changes (-.365). In conclusion, there is a significant correlation between iron profile and changes in blood pressure, with higher iron profile value (lower TIBC) is positively correlated with the increase of both systole and diastole measurement; also negatively correlated with the reduction of blood pressure in hemodialysis patients Keywords: iron; ferritin; intradialytic hypotension; hemodialysis; transferrin; total iron binding capacity

Prevention of Intradialytic Hypotension in Hemodialysis Patients: Current Challenges and Future Prospects.

Intradialytic hypotension, defined as rapid decrease in systolic blood pressure of greater than or equal to 20 mmHg or in mean arterial pressure of greater than or equal to 10 mmHg that results in end-organ ischemia and requires countermeasures such as ultrafiltration reduction or saline infusion to increase blood pressure to improve patient's symptoms, is a known complication of hemodialysis and is associated with several potential adverse outcomes. Its pathogenesis is complex and involves both patient-related factors such as age and comorbidities, as well as factors related to the dialysis prescription itself. Key factors include the need for volume removal during hemodialysis and a suboptimal vascular response which compromises the ability to compensate for acute intravascular volume loss. Inadequate vascular refill, incorrect assessment or unaccounted changes of target weight, acute illnesses and medication interference are further potential contributors. Intradialytic hypotension can lead to compromised tissue perfusion and end-organ damage, both acutely and over time, resulting in repetitive injuries. To address these problems, a careful assessment of subjective symptoms, minimizing interdialytic weight gains, individualizing dialysis prescription and adjusting the dialysis procedure based on patients' risk factors can mitigate negative outcomes.

The role of plasma volume and fluid overload in the tolerance to ultrafiltration and hypotension in hemodialysis patients

Introduction Ultrafiltration (UF) in hemodialysis (HD) patients is accompanied by irregular falls in plasma volume (PV) and blood pressure (BP). Methods We obtained in 321 patients (large cohort), body weight (BW), BP, samples of blood to determine hemoglobin (Hb) and hematocrit (Ht), Pre and Post HD. We estimated the % variation of the PV and its effect on the BP. In a small cohort of 38/321 patients, arterial blood was drawn Pre and Post HD and at 2, 48, and 72 h to determined Hb and Ht and % variation of the PV. Bio-impedance spectroscopy (BIS) was performed, in the same times, to estimate: dry weight (DW), total body water (TBW), extracellular water (ECW), Fluid overload (FO) and phase angle (PhA). Results We divided our large cohort in two groups. The Hypotensive group with a fall equal or more than 20 mmHg (96/321,30%) and Normotensive group with a drop equal or less than 19 mmHg (225/321,70%). The UF was 2.73 ± 0.72 L in the Hypotensive group and 2.53 ± 0.85 L in the Normotensive group (p < 0.0001). The % PV was −11.7 ± 17.8 in the Hypotensive group and −8.53 ± 10.07 in the Normotensive group (p < 0.0001). The systolic blood pressure (SBP) correlated with the % change of the PV (r = -0.232; p < 0.0001). The FO was contrasted with the % of water removed by UF (r = -0.890; p < 0.0001). Conclusion The SBP drop was secondary to the fall in the PV after UF. The FO was irregular and modulates in part the fall in the SBP.

Application of Predictive Nursing in Reducing the Occurrence of Hypotension in Hemodialysis Patients

Application of Predictive Nursing in Reducing the Occurrence of Hypotension in Hemodialysis Patients

Perbedaan Tekanan Darah Sebelum dan Sesudah Exercise Intradialysis Pada Pasien Hemodialisis di Unit Hemodialisis Rumah Sakit Panti Rahayu Gunung Kidul

ABSTRACT&#x0D; Background:Hemodialysis defines as a process of cleaning the blood from waste substances through a filtering process outside the body. Patients with chronic renal failure undergoing hemodialysis often experience complications including hypotension. Several references state an alternative intervention to prevent complications of hypotension in hemodialysis patients with an Intradialytic exercise. Intradialytic exercise is a planned and gradual form of exercise that includes various stages of flexibility exercise, strengthening exercise and cardiovascular exercise performed during hemodialysis. Intradialytic exercise is aimed to improve the work of the heart, respiration and improve hemodialysis regulation for the better.&#x0D; Objective:This study was aimed to determine the difference in blood pressure before and after intradialytic exercise in patients undergoing hemodialysis.&#x0D; Methods:This research design used a quasi-experimental design with pre-test and post-test with control design. The samples were 38 respondents who taken by total sampling at the Hemodialysis Unit of Panti Rahayu Hospital. The samples were divided into the intervention group who undertook intradialytic exercise for 4 weeks, each respondent experiences twice a week, while the control group who did routine hemodialysis and independent exercise.&#x0D; Results:The results showed that the distribution of the characteristics of the respondents was 51-54 years old (18.41%) the sex was mostly male (63.2%) Most of them (55.3%) underwent hemodialysis for less than 2 years. Statistically, it was known that there was no significant difference in blood pressure before and after intradialytic exercise inside patient’s body of the control and intervention groups. There was no significant difference in blood pressure between the intervention group compared to the control group, but there was a dynamic difference in blood pressure in patients who did intradialytic exercise.&#x0D; Conclusion:There was dynamics of differences in blood pressure in patients undergoing intradialytic exercise, it is recommended that hemodialysis nurses at Panti Rahayu Hospital take care patients during hemodialysis so that these interventions are routinely carried out.

Perbedaan Tekanan Darah Sebelum dan Sesudah Exercise Intradialysis Pada Pasien Hemodialisis di Unit Hemodialisis Rumah Sakit Panti Rahayu Gunung Kidul

ABSTRACT&#x0D; Background: Hemodialysis defines as a process of cleaning the blood from waste substances through a filtering process outside the body. Patients with chronic renal failure undergoing hemodialysis often experience complications including hypotension. Several references state an alternative intervention to prevent complications of hypotension in hemodialysis patients with an Intradialytic exercise. Intradialytic exercise is a planned and gradual form of exercise that includes various stages of flexibility exercise, strengthening exercise and cardiovascular exercise performed during hemodialysis. Intradialytic exercise is aimed to improve the work of the heart, respiration and improve hemodialysis regulation for the better.&#x0D; Objective: This study was aimed to determine the difference in blood pressure before and after intradialytic exercise in patients undergoing hemodialysis.&#x0D; Methods: This research design used a quasi-experimental design with pre-test and post-test with control design. The samples were 38 respondents who taken by total sampling at the Hemodialysis Unit of Panti Rahayu Hospital. The samples were divided into the intervention group who undertook intradialytic exercise for 4 weeks, each respondent experiences twice a week, while the control group who did routine hemodialysis and independent exercise.&#x0D; Results: The results showed that the distribution of the characteristics of the respondents was 51-54 years old (18.41%) the sex was mostly male (63.2%) Most of them (55.3%) underwent hemodialysis for less than 2 years. Statistically, it was known that there was no significant difference in blood pressure before and after intradialytic exercise inside patient’s body of the control and intervention groups. There was no significant difference in blood pressure between the intervention group compared to the control group, but there was a dynamic difference in blood pressure in patients who did intradialytic exercise.&#x0D; Conclusion: There was dynamics of differences in blood pressure in patients undergoing intradialytic exercise, it is recommended that hemodialysis nurses at Panti Rahayu Hospital take care patients during hemodialysis so that these interventions are routinely carried out.

Coronary Artery Calcification Is a Risk Factor for Intradialytic Hypotension in Hemodialysis Patients

Coronary Artery Calcification Is a Risk Factor for Intradialytic Hypotension in Hemodialysis Patients

Serum Phosphorus Levels are Associated with Intradialytic Hypotension in Hemodialysis Patients

Background: Intradialytic hypotension (IDH) is a common serious complication in hemodialysis (HD) patients. Hyperphosphatemia is also common in HD patients and promotes vascular calcification. Given the association between vascular calcification and IDH, we investigated the association between IDH and serum phosphorus in HD patients. Methods: We enrolled 173 patients who received HD for 3 months or more. IDH was defined as a nadir systolic blood pressure (SBP) <90 mm Hg or as a decrease in SBP ≥20 mm Hg or a decrease in mean arterial pressure by 10 mm Hg with the occurrence of hypotension-related symptoms requiring intervention. Serum phosphorus levels were analyzed both as a continuous variable and as a categorical variable. Results: IDH occurred in 40 (23.1%) of the 173 patients. The mean phosphorus level was 4.9 mg/dL. A 1 mg/dL higher serum phosphorus resulted in a 2.1-fold greater odds of IDH. The fully adjusted odds ratio (OR) and 95% confidence interval (CI) were 2.11 (1.48–3.01). High categorized phosphorus levels were also associated with IDH. The highest tertile of serum phosphorus was associated with 6.5-fold greater odds of developing IDH compared to the referent group (the middle tertile of serum phosphorus, 4.0–<5.3 mg/dL); the fully adjusted OR (95% CIs) were 6.53 (2.23–19.09). In subgroup analyses, diabetes and pre-dialysis SBP modified the association between IDH and phosphorus levels, with a more pronounced association in diabetic patients and pre-dialysis SBP ≥140 mm Hg. Conclusion: In HD patients, higher phosphorus levels were associated with an increased occurrence of IDH.

Clinical characteristics of arterial hypotension in hemodialysis patients

Clinical characteristics of arterial hypotension in hemodialysis patients

Association of Body Composition and Intradialytic Hypotension in Hemodialysis Patients

Background/Aim: The relationship between body mass index (BMI) and intradialytic hypotension (IDH) has been inconsistently reported, but no further research has investigated the correlation between body composition and IDH so far. This study aimed to determine whether the lean tissue index (LTI), fat tissue index (FTI), or both derived from body composition monitoring (BCM) is associated with IDH defined as a nadir intradialytic systolic blood pressure of <90 mm Hg and ≥3 episodes hypotension per 10 hemodialysis (HD) treatments in patients undergoing prevalent HD. Methods: The observational cohort study comprised 1,463 patients receiving thrice-weekly HD from 13 dialysis centers. LTI and FTI were assessed using a BCM machine, a multifrequency bioimpedance spectroscopy device. Unadjusted and multivariable adjusted logistic regression models were fit to estimate the association of body composition with the odds of developing IDH. Results: One hundred and seven patients (7.3%) were diagnosed as IDH. The difference in dialysis vintage, BMI, FTI, LTI, high-density lipoprotein cholesterol, and C-reactive protein between IDH and non-IDH groups was statistically significant (all p < 0.05). The prevalence of diabetes among IDH patients was slightly higher than among non-IDH patients. In logistic regression models, low LTI and high FTI, but not high BMI were associated with greater odds of IDH (“high” as above median and “low” as below median). When patients were further stratified into 4 distinct body composition groups based on both the LTI and FTI, only the low LTI/high FTI group was connected with a significantly higher odds of IDH (OR 2.686, 95% CI 1.072–6.734; reference: low LTI/low FTI group). Conclusions: The LTI and FTI can provide better correlation of IDH occurrence than the BMI alone in prevalent HD patients. The low LTI/high FTI appears to be most associated with IDH. An optimal body composition for preventing the occurrence of IDH needs to be determined.

Improvement of IDWG Related to Hypotension Events in Hemodialysis Patients

Hemodialysis which is one of the treatments performed on patients with kidney failure has been done with the help of 15% / minute / 1.73. While hemodialysis is safe and beneficial for patients, it does not mean that it has no side effects, one of which is an increase in IDWG. Increase in body weight between IDWG hemodialysis or Interdialytic Weight Gain has side effects that often occur as well, one of which occurs intradialisis hypotension. The study aims to determine the relationship of increased IDWG with the incidence of hypotension in hemodialysis patients at the Rasyida Kidney Hospital in Medan. Quantitative research design with analytic surveys conducted through cross sectional research. The population in this study were chronic kidney failure patients who performed hemodialysis at the Rasyida Kidney Hospital in Medan, with a total of 380, with a sample of 22 respondents using purposive sampling. The majority of hemodialysis patients in Medan Rasyida Kidney Special Hospital approve&gt; 50 years (50%), and 50% are male and 50% female, 50% of patients can be hypotensive and increase IDWG. Chi square test results obtained p-value of 0,000. So, it can be concluded that there is a relationship between an increase in IDWG and the incidence of hypotension in hemodialysis patients.

A Synthetic Data Mining Model for Evaluating Hypotension in Hemodialysis Patients

مقدمه: افت فشار خون حین دیالیز در بیمارانی که به مدت طولانی تحت دیالیز قرار می­گیرند، اغلب با افزایش مرگ و میر همراه است. پژوهش حاضر با هدف سنجش میزان افت فشارخون بیماران همودیالیزی به ارائه مدلی پیش بینانه از طریق داده­کاوی توصیفی پرداخته است. زیرا، افت فشار خون شایع­ترین عارضه جدی حین همودیالیز است. روش ­ها: پژوهش حاضر به روش توصیفی- مقطعی صورت گرفته است. جامعه­ی پژوهش متشکل از داده­ های بیمارستان علی ابن ابی طالب (ع) زاهدان در خردادماه ۹۵ است. جهت تحلیل داده ­ها از نرم افزار Clementine۱۲.۰ استفاده شده است. برای مدل­سازی از الگوریتم­های K-Means، C۵.۰ و CART استفاده گردید. یافته ‏ها: پارامترهای تاثیرگذار در میزان افت فشار خون شامل نوع صافی و دور پمپ بود. بررسی خوشه­بندی و قوانین استخراج شده از مدل، اهمیت تاثیر نوع صافی و دور پمپ را تصدیق نمود. نتیجه­ گیری: استفاده از رو­ش ­های نوین مدل­سازی برای تحلیل وکشف ارتباطات بین داده ­های دیالیز، باعث ایجاد تغییر در نحوه­ی نگرش پرسنل بخش دیالیز نسبت به روند انجام دیالیز و مراقبت ­های لازم حین آن می ­شود. سنجش میزان افت فشار خون بیماران دیالیزی به شناسایی سریع­تر و دقیق­تر افت فشار و مدیریت صحیح و پیشگیرانه کمک می­نماید و منجر به ارتقای عملکرد بخش دیالیز می­ گردد. مطالعه حاضر نشان داد نوع صافی به جهت تاثیر آن روی افت فشار خون بیمار اهمیت دارد.

Associations between serum fibroblast growth factor 23 level and intradialytic hypotension in hemodialysis patients

Objectives: To explore possible link between intradialytic hypotension (IDH) with serum fibroblast growth factor 23 (FGF23) and serum soluble klotho (sKl) in maintenance hemodialysis (MHD) patients in a single dialysis center. Materials and Methods: Cross-sectional data were collected from MHD patients. Intradialytic blood pressure was recorded continuously in a 1-month period. According to the dialysis records, MHD patients were divided into IDH group and non-IDH group. Fast sera of the MHD patients were obtained for FGF23 and sKl assay at the end of IDH record month, and other routing laboratory results were analyzed statistically for comparison between the two groups. Results: A total of eighty MHD patients with complete laboratory data were enrolled into the study. The occurrence rate of IDH was 77.5%. The significant differences in serum ferritin (P = 0.046), serum triglyceride (P = 0.045), parathyroid hormone (P = 0.042), calcium-phosphorus product (P = 0.047), and serum FGF23 (P

Vascular calcification and intradialytic hypotension in hemodialysis patients: Clinical relevance and impact on morbidity and mortality

BackgroundVascular calcification (VC) and intradialytic hypotension (IDH) indicate morphological and functional disorders of the cardiovascular system in hemodialysis (HD) patients. However, their relationship and combined effects on clinical outcomes remain undetermined. MethodsHD patients (n=443) whose plain chest radiographs were examined for aortic arch VC were included. IDH was defined as nadir systolic blood pressure <90mmHg or need for bolus fluid. We investigated the relationship between VC and IDH, and their clinical significance for cardiovascular events (CVEs) and death. ResultsVC was found in 57 HD patients (12.9%). IDH was more prevalent in patients with VC compared with those without VC (35.1% vs. 18.7%; P=0.004). VC was independently associated with a 2.12-fold increase in the risk of IDH (95% confidence interval [CI], 1.03–4.36). In multivariate analysis, compared with patients with neither VC nor IDH, the coexistence of VC and IDH was independently associated with death (hazard ratio [HR], 3.83; 95% CI, 1.62–9.08) and CVE (HR, 3.77; 95% CI, 1.53–9.33), whereas VC or IDH alone was not. Patients with both VC and IDH had the highest risk for a composite event (HR, 3.56; 95% CI, 1.79–7.08). Significant synergistic interaction was observed between VC and IDH (P for interaction=0.009). ConclusionsVC was independently associated with IDH. Coexistence of VC and IDH was associated with higher risk of death and CVEs than either factor alone. There was a synergistic interaction between VC and IDH for the risk of a composite event.

Risk of Intradialytic Hypotension in Hemodialysis Patients with Different Residual Urine Volume

Background: Relationship between intradialytic hypotension (IDH) and residual urine volume (RUV) in hemodialysis (HD) patients remained unclear. In the present study, we aimed to evaluate the risk of intradialytic hypotension in hemodialysis patients with different residual urine volume. Method: This work was a prospective observational study of incident and prevalent HD patients. From January 1, 2013 to February 28, 2014, patients were recruited from a single HD center of the Second Affiliated Hospital of Nanchang University. Eligible patients were categorized into three groups: group A (RUV > 400 ml/24 hours), group B (RUV of 100-400 ml/24 hours) and group C (RUV < 100 ml/24 hours). A Logistic regression model was used to examine patient characteristics associated with predictive odds of RUV with 100-400 ml/24 hours and < 100 ml/24 hours. Hazard ratio (HR) of IDH was calculated by the Cox proportional hazards model for three groups. Results: Totally, 150 HD patients were enrolled in this study, with mean follow-up of 9.9 ± 5.1 months. Older age, longer HD vintage and lower levels of hemoglobin were independently associated with RUV with 100-400 ml/24 hours, whereas thrice-weekly HD, longer HD vintage, diabetes and lower levels of phosphate were independently associated with RUV 400 ml/24 hours, even when extensive demographics, comorbidities and lab adjustments were made. Similarly, in a maximally adjusted model, risk of IDH in patients with RUV of 100-400 ml/24 hours was 2.36 times than that in those with RUV > 400 ml/24 hours (95% CI 1.75-7.47, p=0.043). Conclusion: HD patients with lower RUV may have an increased risk of presenting IDH, which suggested that preserving RUV may be conducive to preventing of IDH occurrence.

Prediction of hypotension in hemodialysis patients

Intradialytic hypotension (IDH) is the most common adverse complication during hemodialysis. Its early prediction and prevention will dramatically improve the quality of life for patients with an end stage renal disease. In a recent study, changes in the normalized envelope of the test statistic of the photoplethysmograpic (PPG) signal were found to predict acute symptomatic IDH. In the present study, the PPG-based predictor is generalized to include a patient-dependent threshold which incorporates on-line information on heart rate variability and heart rate turbulence. From datasets with patients prone and resistant to IDH, the results show that symptomatic IDH could be correctly predicted in 9 out of 14 cases, while 5 out of 24 were falsely predicted. In a subset of the data containing only patients prone to IDH, acute symptomatic IDH could be correctly predicted in 5 out of 5 cases, with one false prediction out of 14. When testing the robustness of the predictor, no significant changes were observed in the test statistic when controlled changes occurred in dialysis fluid temperature, ultrafiltration rate and body position.

Parathyroidectomy Reduces Intradialytic Hypotension in Hemodialysis Patients with Secondary Hyperparathyroidism

Background: Secondary hyperparathyroidism is associated with vascular calcification and arterial stiffness in patients with end-stage renal disease. The aim of this study was to analyze the frequency of intradialytic hypotension (IDH) and cardiovascular function before and after parathyroidectomy (PTX) in maintenance hemodialysis patients. Methods: We compared predialytic and intradialytic blood pressure, left and right ventricular ejection fraction (LVEF and RVEF), and cardiothoracic ratio 1 month before PTX, and 6 and 12 months after PTX. IDH was defined as a decrease in systolic blood pressure ≥ 20 mmHg or a decrease in mean arterial pressure ≥ 10 mmHg. Results: At the time of PTX, the mean age of the patients was 57.4 ± 12.0 years, and the mean dialysis vintage was 12.2 ± 5.8 years. At baseline, 6 months, and 12 months after PTX, the average numbers of sessions disturbed by IDH during 13 dialysis sessions (1 month) were 6.4, 3.9 (p < 0.016 vs. baseline), and 4.0 sessions (p < 0.037 vs. baseline, p = 0.801 vs. 6 months), respectively. LVEF and RVEF were improved significantly after PTX. Furthermore, volume status was also improved, as evidenced by the significantly greater ultrafiltration volume and reduced cardiothoracic ratio. Conclusions: Hemodialysis patients with severe secondary hyperparathyroidism are more likely to achieve normotensive and euvolemic status after PTX, probably through improved heart function and reduced IDH episodes.

Genetic Polymorphisms of Hypoxia-Inducible Factor-1 Alpha and Cardiovascular Disease in Hemodialysis Patients

Background: Hemodialysis patients are prone to ischemic events potentially aggravated by hypoxia. The key player in adaptation to hypoxia is hypoxia-inducible factor-1 alpha (HIF-1α). Therefore, we investigated the association of HIF-1α polymorphisms with ischemia/hypoxia-related events in hemodialysis patients. Methods: Patients on maintenance hemodialysis were enrolled from 4 training hospitals in Korea. Seven single nucleotide polymorphisms (SNP) of HIF-1α were genotyped. The association of these SNP with hypoxia-related clinical outcomes (ischemic diseases and anemia) and cancer was analyzed. Results: A total of 376 patients participated in the study. No significant difference in genotype distribution was found between subjects with and without the hypoxia-related events. Three sets of linkage disequilibrium blocks were made for haplotype analyses (rs2783778 and rs7148720 in 5′ upstream region; rs7143164 and rs10873142; rs2301113, rs11549465 and rs2057482). Of these, the CT haplotype in the first set was associated with both acute myocardial infarction and frequent intradialytic hypotension (acute myocardial infarction: adjusted odds ratio = 0.15, 95% CI: 0.03–0.69; frequent intradialytic hypotension: adjusted odds ratio = 0.29, 95% CI: 0.12–0.72). Conclusion: Genetic polymorphisms of HIF-1α were associated with acute myocardial infarction and intradialytic hypotension in hemodialysis patients.