Abstract: 【Abstract】Objective To evaluate the value of pre-dialysis plasma osmolality for the prediction of frequent-intradialytic hypotension (f-IDH) in hemodialysis (HD) patients. Methods A total of 100 HD patients with f-IDH treated in Hangzhou Hospital of Traditional Chinese Medicine Affiliated to Zhejiang Traditional Chinese Medicine University from June 2020 to May 2021 were enrolled as the case group. By frequency matching method, 100 HD patients without f-IDH with the ratios of age, gender and diabetes comparable to those in the case group were enrolled as the control group. The risk factors for f-IDH were analyzed by logistic regression analysis, and the diagnostic value of pre-dialysis plasma osmolarity for f-IDH was evaluated by area under the receiver operating characteristic (ROC) curve (AUC). Results In the case group, serum parathyroid hormone (Z=-2.889, P=0.004), triglyceride (Z=-3.422, P=0.001), pre- dialysis plasma osmolarity (t=2.642, P=0.009), and average ultrafiltration volume/dry weight (t=3.700, P＜0.001) were higher than those in the control group, while serum albumin (t=2.402, P=0.018) was lower than that in the control group. Binary logistic regression analysis revealed that lower albumin (OR=0.847, 95% CI 0.723～0.992, P= 0.040), higher predialysis plasma osmolarity (OR=1.255, 95%CI 1.00～1.112, P=0.035) and higher average ultrafiltration volume/
dry weight (OR=1.719, 95% CI 1.225～2.412, P=0.002) were the independent risk factors for f-IDH in HD patients. ROC analysis showed that the AUC of pre-dialysis plasma osmolarity for the diagnosis of f-IDH was 0.702, with the cut-off value of 304.65 mOsm/Kg.H2O. Conclusion Higher pre-dialysis plasma osmolarity was an independent risk factors for f-IDH and can be used as a predictor for f-IDH in HD patients.

Key words: Hemodialysis, Hypotension, Plasma osmolality