Intradialytic Hypertension / Hypotension and Mortality in San Juan, Puerto Rico.

Abstract

End Stage Renal Disease patients undergo profound hemodynamic changes during hemodialysis treatments which are now recognized as a marker for increased risk of morbidity and mortality. Development of intradialytic hypotension or hypertension are a common clinical problem in this population with an incidence of up to 20%. We performed a retrospective review of 49 Hispanic patients receiving ambulatory hemodialysis during a period of 6 months to ascertain the development of aforementioned intradialytic events. Clinical data examined the association of these events to mortality and their relationship to antihypertensive medications and cardiomegaly. The prevalence of intradialytic hypotension was 38.78%, hypertension 16.33% individually and both taking place 16.33%. Taken together, the prevalence of these intradialytic events was 71.43% in our Hispanic population. A significant association was found between mortality and Beta blockers (BB)(P=0.044), Calcium channel blockers (CCB) (P=0.023), cardiomegaly (P=0.044), and intradialytic events (P=0.035). Odds ratio of multiple variables dis- closed that dependent variable death decreased in probability with the use of BB by an estimate of 73% and with the use of CCB by 74.8%. On the other hand, odds of developing the dependent variable death increased by 74.5% if the patients developed intradialytic events. Similarly, the odds of developing cardiomegaly in the living group increased by 70%. A logistic regression of multiple variables found that the probability of developing the dependent condition of death increases by almost 2.896 times if intradialytic events are present and that there is a 58.9% inferred causality. It is concluded that intradialytic hyper- tension and hypotension are major risk factors for mortality in dialysis patients. The use of BB and CCB may be protetive to avoid the risk of mortality in these patients.