Objective To investigate the independent factors associated with intradialytic hypotension (IDH) in maintenance hemodialysis (MHD) patients and to analyze its impact on 3-year all-cause mortality risk. Methods A retrospective cohort study was conducted, which included 191 MHD patients treated at the Blood Purification Center of Beijing Lu-he Hospital, Capital Medical University, from October to December 2021. According to the occurrence of IDH, the patients were divided into an IDH group (n=50) and a non-IDH group (n=141). Clinical data were collected. Univariate and multivariate logistic regression analyses were performed to identify the independent factors associated with IDH. Kaplan-Meier curve was used, and multivariate Cox proportional hazards regression model was applied to analyze the relationship between IDH and survival prognosis. Results Multivariate logistic regression analysis showed that pre-dialysis systolic blood pressure (OR=0.958, 95% CI: 0.936～0.981, P＜0.001), pre-dialysis creatinine (OR=0.998, 95% CI: 0.997～1.000, P=0.037), and serum albumin (OR=0.769, 95% CI: 0.652～0.907, P=0.002) were the independent factors associated with IDH in MHD patients. Survival analysis revealed that the 3-year cumulative survival rate was significantly lower in the IDH group than in the non-IDH group (42% vs. 72%, log-rank χ²=9.450, P=0.003). To further clarify the independent association between IDH and mortality, multivariate COX regression after adjustment for age, hemoglobin, albumin, pre-dialysis creatinine, diabetes history, and ultrafiltration volume indicated that IDH was not an independent risk factor for 3-year all-cause mortality (HR=1.423, 95% CI: 0.771～2.626, P=0.259). In the adjusted model, age (HR=1.088, P＜0.001) was a risk factor for death, while hemoglobin(HR=0.971,P=0.015) served as a protective factor. Conclusion Lower pre-dialysis systolic blood pressure, serum albumin, and pre-dialysis creatinine levels are the independent factors associated with IDH in MHD patients. IDH is significantly correlated with reduced patient survival, but it primarily reflects the underlying frail state of the patients rather than acting as an independent risk factor for mortality.
Key words
Maintenance hemodialysis /
Intradialytic hypotension /
Associated factor /
Survival analysis
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