Acute intradialytic blood pressure changes in pediatrics; incidence, risk factors and management: single-center experience

Background Despite Hemodialysis (HD) is a relatively safe procedure for End Stage Kidney Disease (ESKD) patients, Intradialytic (ID) hypotension and hypertension are frequently reported complications in many adults’ studies. However, little is known about acute intradialytic complications in children. Objective This study aimed to assess the incidence of acute ID blood pressure (BP) changes among children attending the HD unit at our institute. Furthermore, it assessed the possible risk factors and the management options. Patients and methods All children with ESKD on chronic HD were enrolled. A checklist was fulfilled every dialysis session over a six-month period, including patient’s demographic data, dialysis session details: frequency/week, duration of session, ultrafiltration volume, BP, vital signs, IVC diameter, dry weight and predialysis weight. All cases were subjected to echocardiography for estimation of cardiac function. Results Thirty-two patients with mean age of 9.16±2.48 years, and who dialyzed a total of 2678 sessions, were included in the current study. ID hypotension was the top (71.8%) of all complications with an incidence rate of 12.6% in all sessions, followed by ID hypertension (25.7%) with an incidence rate of 4.5% in all sessions. ID hypotension was significantly associated with males, with predialytic hypertension (P<0.001), high ultrafiltration rate (P0.033), and longer durations of sessions (mean >3.56 h±0.56 h) (P<0.001). However, less duration (mean < 3.33 h±0.55) and a lower percentage of ID weight loss were independent risk factors for the development of ID hypertension. Conclusion ID blood pressure changes are the most frequent complications in our study; hypotension is on the top of list (12.6% per sessions) followed by hypertension (4.5% per sessions). ID blood pressure is influenced by multiple risk factors; mainly by predialytic hypertension, duration of session and ID weight loss.