Abstract

Rationale & Objective: Intradialytic hypotension (IDH) is associated with mortality in adults with kidney failure requiring hemodialysis (HD); however, large-scale pediatric studies are lacking. Moreover, there is no evidence-based consensus definition of IDH in pediatric literature. We aimed to examine the association of commonly used definitions of IDH with mortality in adolescents and young adults.Study Design: This was a retrospective observational cohort study.Setting & Participants: In total, 1,199 adolescents and young adults (N=320, aged 10-18 years and N=879, aged 19-21 years) who initiated HD in a large dialysis organization were included.Exposures: This study used different definitions ofIDH.Outcome: The study outcome was 2-year all-cause mortality.Analytical Approach: Several definitions of IDH were selected a priori based on a literature review. Patients were classified as having IDH if it was present in at least 30% of HD treatments during the first 90 days after dialysis initiation. Cox proportional hazards regression was used to test whether IDH associated with 2-year all-cause mortality.Results: Over a 2-year follow-up period, 54 (4.5%) patients died. Dependent on its definition, IDH was present in 2.9%-61.1% of patients. After the multivariable adjustment for sociodemographic and clinical characteristics, we found no association of IDH with mortality. Results were consistent across subgroups stratified by age (aged<18 and 19-21 years) and predialysis systolic blood pressure (<120, 120-150, and>150mm Hg). We also examined IDH as occurring in<5%, 5%-29%, 30%-50%, and>50% of baseline treatments, and did not find a dose-response association with mortality (P>0.05).Limitations: Owing to low event rates, our current sample size may have been too small to detect a difference in mortality.Conclusions: Our study found that IDH was not associated with mortality in adolescents and young adults.

View details for DOI 10.1016/j.xkme.2023.100773

View details for PubMedID 38317757