High ultrafiltration rate induced intradialytic hypotension is a predictor for cardiac remodeling: a 5-year cohort study. Issue 1 (1st January 2021)

• Record Type: Journal Article
• Authors: Yu, Jinbo; Chen, Xiaohong; Li, Yang; Wang, Yaqiong; Liu, Zhonghua; Shen, Bo; Teng, Jie; Zou, Jianzhou; Ding, Xiaoqiang
• Is Part Of: Renal failure. Volume 43:Issue 1(2021)
• Page Start: 40
• Page End: 48
• Publication Date: 2021-01-01
• Subjects: Intradialytic hypotension -- cardiac remodeling -- ultrafiltration rate -- hemodialysis -- left ventricular mass index; Chronic renal failure -- Periodicals; Acute renal failure -- Periodicals; Uremia -- Periodicals; 616.614005
• DOI: 10.1080/0886022X.2020.1853570
• Languages: English
• ISSNs: 0886-022X

Abstract

Abstract: Background: Intradialytic-hypotension (IDH) is a common complication of hemodialysis. High ultrafiltration rate (UFR) might lead to IDH. However, the relationships between UFR, IDH, and cardiac remodeling among hemodialysis patients in the long-term have not been deeply explored. Methods: This retrospective cohort study collected clinical and echocardiographic data. Patients were enrolled from 1 January 2014 to 31 March 2014 and were followed-up for 5-year. Those who suffered from more than four hypotensive events during three months (10% of dialysis treatments) were defined as the IDH group. Subgroup analysis was done according to the UFR of 10 ml/h/kg. Associations between UFR, IDH, and alterations of cardiac structure/function were analyzed. Results: Among 209 patients, 96 were identified with IDH (45.9%). The survival rate of IDH patients was lower than that of no-IDH patients (65.5% vs. 81.4%, p = .005). In IDH group, decreased ejection fraction (EF), larger left atrium diameter index (LADI), and left ventricular mass index (LVMI) ( p < .05) were observed at the end of the follow-up. In multivariate logistic model, the interaction between UFR and IDH was notably associated with LVMI variation ( OR = 1.37). After adjusting covariates, UFR was still an independent risk factor of LVMI variation ( OR = 1.52) in IDH group. In subsequent analysis, we divided patients according to UFR 10 ml/h/kg. For IDH-prone patients, decreased EF, larger LADI, and LVMI ( p < .05) were observed at the end of the study only in high-UFR group. Conclusions: UFR and IDH have interactions on cardiac remodeling. High ultrafiltration rate induced IDH is a predictor for cardiac remodeling in long-term follow-up.