Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
Copyright © 2023 The Korean Society of Critical Care Medicine
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICT OF INTEREST
No potential conflict of interest relevant to this article was reported.
FUNDING
None.
AUTHOR CONTRIBUTIONS
Conceptualization: SGK, KWJ, SSH. Data curation: JL, YCK, YSK. Formal analysis: SGK, DY, DKK, KHO. Methodology: DY, DKK, KHO, KWJ. Project administration: YSK. Writing–original draft: SGK. Writing–review & editing: SSH.
Outcome | Unadjusted OR (95% CI) | P-value | Adjusted OR (95% CI)a) | P-value |
---|---|---|---|---|
IDH | 3.33 (2.258–4.914) | <0.001 | 2.57 (1.632–4.040) | <0.001 |
IDH–Ab) | 3.33 (2.182–5.076) | <0.001 | 2.71 (1.600–4.643) | <0.001 |
IDH–Bb) | 2.46 (1.631–3.694) | <0.001 | 2.35 (1.443–3.834) | 0.001 |
IDH: intradialytic hypotension; OR: odds ratio; CI: confidence interval; SOFA: Sequential Organ Failure Assessment.
a)Adjusted for age, sex, septic acute kidney injury, systolic blood pressure, pulse rate, urine output, mechanical ventilation, use of vasopressors, SOFA score, Charlson comorbidity index, hemoglobin, platelet, total bilirubin, and albumin;
b)IDH was defined as a discontinuation of dialysis because of hemodynamic instability plus a nadir systolic blood pressure <90 mm Hg (IDH-A) or a decrease in systolic blood pressure ≥30 mm Hg (IDH-B).
Variable |
IDH |
IDH–Aa) |
IDH–Ba) |
|||
---|---|---|---|---|---|---|
OR (95% CI) | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value | |
Age (per 10 yr) | 1.10 (0.970–1.257) | 0.135 | 1.15 (0.973–1.350) | 0.103 | 1.12 (0.972–1.282) | 0.118 |
Female (vs. male) | 1.23 (0.836–1.802) | 0.295 | 1.25 (0.787–1.999) | 0.341 | 1.47 (0.972–2.213) | 0.068 |
Systolic blood pressure (per 10 mm Hg) | 0.92 (0.834–1.003) | 0.058 | 0.68 (0.594–0.768) | <0.001 | 1.15 (1.033–1.274) | 0.010 |
Pulse rate (per 10 beats/min) | 1.33 (1.191–1.485) | <0.001 | 1.35 (1.187–1.534) | <0.001 | 1.31 (1.170–1.475) | 0.001 |
Transition after 24 hr (vs. within 24 hr) | 1.13 (0.873–1.471) | 0.348 | 1.15 (0.826–1.556) | 0.397 | 0.99 (0.746–1.311) | 0.937 |
Hemodialysis duration (per 1 hr) | 0.61 (0.314–1.191) | 0.148 | 0.67 (0.298–1.526) | 0.355 | 0.63 (0.304–1.303) | 0.213 |
Ultrafiltration volume (per 1 L) | 1.10 (0.898–1.354) | 0.348 | 1.05 (0.831–1.336) | 0.665 | 0.99 (0.794–1.232) | 0.989 |
Urine output (per 100 ml/day) | 0.96 (0.921–0.998) | 0.038 | 0.97 (0.925–1.023) | 0.259 | 0.96 (0.964–1.007) | 0.096 |
Mechanical ventilation (%) | 1.71 (1.121–2.553) | 0.012 | 1.39 (0.848–2.284) | 0.191 | 1.40 (0.900–2.178) | 0.136 |
Use of vasopressor (vs. none) | 1.91 (1.212–3.015) | 0.005 | 2.84 (1.719–4.691) | <0.001 | 1.72 (1.053–2.794) | 0.030 |
Albumin (per 1 g/dl) | 0.71 (0.470–1.055) | 0.089 | 0.51 (0.311–0.845) | 0.009 | 1.00 (0.656–1.524) | 0.998 |
Variable | Overall (n=541) | Non-IDH (n=344) | IDH (n=197) | P-value |
---|---|---|---|---|
Age (yr) | 64.2±15.3 | 63.8±15.9 | 64.9±14.0 | 0.416 |
Female (%) | 39.5 | 38.4 | 42.6 | 0.330 |
Body mass index (kg/m2) | 23.2±4.5 | 23.3±4.5 | 23.5±4.7 | 0.573 |
Septic acute kidney injury (%) | 49.7 | 47.4 | 53.8 | 0.150 |
Transition after 24 hr (%) | 25.5 | 27.8 | 22.3 | 0.219 |
Systolic blood pressure (mm Hg) | 123.8±21.3 | 125.4±18.6 | 120.6±25.0 | 0.020 |
Diastolic blood pressure (mm Hg) | 68.3±13.5 | 68.0±13.1 | 68.8±14.3 | 0.524 |
Mean arterial pressure (mm Hg) | 86.8±13.7 | 87.1±12.8 | 86.1±15.2 | 0.401 |
Pulse rate (beats/min) | 91.1±18.7 | 87.9±16.9 | 96.4±20.1 | <0.001 |
Hemodialysis duration (hr) | 3.0±0.3 | 3.0±0.3 | 3.0±0.2 | 0.213 |
Ultrafiltration volume (L) | 1.0 (0.5–1.8) | 1.0 (0.5–1.8) | 1.1 (0.5–1.8) | 0.467 |
Urine output (ml/day) | 159.0 (35.0–546.0) | 195.0 (45.0–684.0) | 105.0 (30.0–312.0) | 0.001 |
Mechanical ventilation (%) | 29.9 | 24.1 | 39.1 | <0.001 |
Use of vasopressors (%) | 22.0 | 16.2 | 32.0 | <0.001 |
SOFA score | 8.9±2.8 | 8.6±2.7 | 9.4±2.7 | <0.001 |
Charlson comorbidity index | 3 (2–5) | 3 (2–5) | 3 (2–4) | 0.641 |
Previous history (%) | ||||
Myocardial infarction | 10.9 | 11.9 | 9.1 | 0.318 |
Congestive heart failure | 22.2 | 24.7 | 19.8 | 0.161 |
Diabetes | 34.0 | 34.6 | 33.0 | 0.706 |
Stroke | 13.7 | 15.4 | 10.7 | 0.102 |
Liver cirrhosis | 4.4 | 4.7 | 4.1 | 0.748 |
Active malignancy | 32.7 | 32.0 | 34.0 | 0.628 |
Blood finding | ||||
Hemoglobin (g/dl) | 9.3±1.4 | 9.4±1.4 | 9.3±1.3 | 0.599 |
Platelet (×103/ml) | 81.0 (49.0–120.0) | 82.0 (51.8–123.3) | 78.0 (43.0–118.0) | 0.162 |
Blood urea nitrogen (mmol/l) | 29.0 (20.0–40.0) | 29 (19.5–41.0) | 28 (21.0–39.0) | 0.463 |
Creatinine (mg/dl) | 1.7 (1.3–2.4) | 1.7 (1.3–2.5) | 1.8 (1.3–2.4) | 0.938 |
Sodium (mmol/l) | 135.8±3.4 | 135.9±3.3 | 135.8±3.5 | 0.337 |
Potassium (mmol/l) | 4.0±0.5 | 4.0±0.5 | 3.9±0.5 | 0.302 |
Chloride (mmol/l) | 100.8±3.5 | 100.9±3.5 | 100.8±3.6 | 0.808 |
Calcium (mg/dl) | 8.6±0.7 | 8.6±0.7 | 8.5±0.6 | 0.117 |
Phosphate (mg/dl) | 3.1 (2.5–3.8) | 3.1 (2.5–3.8) | 3.1 (2.5–3.9) | 0.234 |
Total bilirubin (mg/dl) | 1.8 (0.9–5.0) | 1.7 (0.9–4.5) | 2.0 (0.9–5.8) | 0.210 |
Albumin (g/dl) | 2.8 (2.6–3.2) | 2.9 (2.6–3.2) | 2.8 (2.5–3.1) | 0.060 |
Variable | Odds ratio (95% CI) | P-value |
---|---|---|
Age (per 10 yr) | 1.03 (0.906–1.159) | 0.693 |
Female (vs. male) | 0.70 (0.476–1.039) | 0.077 |
Body mass index (per 1 kg/m2) | 1.01 (0.967–1.053) | 0.675 |
Septic acute kidney injury (vs. nonseptic) | 2.18 (1.480–3.197) | <0.001 |
Transition after 24 hr (vs. within 24 hr) | 1.25 (0.973–1.604) | 0.081 |
Systolic blood pressure (per 10 mm Hg) | 0.88 (0.804–0.963) | 0.005 |
Diastolic blood pressure (per 10 mm Hg) | 1.01 (0.878–1.160) | 0.900 |
Mean arterial pressure (per 10 mm Hg) | 0.91 (0.791–1.041) | 0.166 |
Pulse rate (per 10 beat/min) | 1.29 (1.159–1.432) | 0.001 |
Hemodialysis duration (per 1 hr) | 0.96 (0.521–1.748) | 0.880 |
Ultrafiltration volume (per 1 L) | 1.03 (0.842–1.248) | 0.806 |
Urine output (per 100 ml/day) | 0.96 (0.923–1.000) | 0.049 |
Mechanical ventilation (%) | 2.28 (1.534–3.383) | <0.001 |
Use of vasopressors (vs. none) | 1.61 (1.041–2.473) | 0.032 |
SOFA score (per 1 score) | 1.23 (1.146–1.327) | <0.001 |
Charlson comorbidity index (per 1 score) | 1.07 (0.988–1.154) | 0.097 |
Blood finding | ||
Hemoglobin (per 1 g/dl) | 0.88 (0.765–1.020) | 0.090 |
Platelet (per ×103/ml) | 0.99 (0.988–0.996) | 0.001 |
Blood urea nitrogen (per 1 mmol/l) | 1.00 (0.987–1.010) | 0.754 |
Creatinine (per 1 mg/dl) | 0.89 (0.740–1.075) | 0.230 |
Sodium (per 1 mmol/l) | 0.99 (0.938–1.049) | 0.776 |
Potassium (per 1 mmol/l) | 1.02 (0.707–1.458) | 0.933 |
Chloride (per 1 mmol/l) | 0.99 (0.937–1.042) | 0.662 |
Calcium (per 1 mg/dl) | 1.00 (0.771–1.303) | 0.985 |
Phosphate (per 1 mg/dl) | 1.07 (0.893–1.290) | 0.450 |
Total bilirubin (per 1 mg/dl) | 1.08 (1.049–1.104) | <0.001 |
Albumin (per 1 g/dl) | 0.62 (0.415–0.934) | 0.022 |
Outcome | Unadjusted OR (95% CI) | P-value | Adjusted OR (95% CI) |
P-value |
---|---|---|---|---|
IDH | 3.33 (2.258–4.914) | <0.001 | 2.57 (1.632–4.040) | <0.001 |
IDH–A |
3.33 (2.182–5.076) | <0.001 | 2.71 (1.600–4.643) | <0.001 |
IDH–B |
2.46 (1.631–3.694) | <0.001 | 2.35 (1.443–3.834) | 0.001 |
Variable | IDH |
IDH–A |
IDH–B |
|||
---|---|---|---|---|---|---|
OR (95% CI) | P-value | OR (95% CI) | P-value | OR (95% CI) | P-value | |
Age (per 10 yr) | 1.10 (0.970–1.257) | 0.135 | 1.15 (0.973–1.350) | 0.103 | 1.12 (0.972–1.282) | 0.118 |
Female (vs. male) | 1.23 (0.836–1.802) | 0.295 | 1.25 (0.787–1.999) | 0.341 | 1.47 (0.972–2.213) | 0.068 |
Systolic blood pressure (per 10 mm Hg) | 0.92 (0.834–1.003) | 0.058 | 0.68 (0.594–0.768) | <0.001 | 1.15 (1.033–1.274) | 0.010 |
Pulse rate (per 10 beats/min) | 1.33 (1.191–1.485) | <0.001 | 1.35 (1.187–1.534) | <0.001 | 1.31 (1.170–1.475) | 0.001 |
Transition after 24 hr (vs. within 24 hr) | 1.13 (0.873–1.471) | 0.348 | 1.15 (0.826–1.556) | 0.397 | 0.99 (0.746–1.311) | 0.937 |
Hemodialysis duration (per 1 hr) | 0.61 (0.314–1.191) | 0.148 | 0.67 (0.298–1.526) | 0.355 | 0.63 (0.304–1.303) | 0.213 |
Ultrafiltration volume (per 1 L) | 1.10 (0.898–1.354) | 0.348 | 1.05 (0.831–1.336) | 0.665 | 0.99 (0.794–1.232) | 0.989 |
Urine output (per 100 ml/day) | 0.96 (0.921–0.998) | 0.038 | 0.97 (0.925–1.023) | 0.259 | 0.96 (0.964–1.007) | 0.096 |
Mechanical ventilation (%) | 1.71 (1.121–2.553) | 0.012 | 1.39 (0.848–2.284) | 0.191 | 1.40 (0.900–2.178) | 0.136 |
Use of vasopressor (vs. none) | 1.91 (1.212–3.015) | 0.005 | 2.84 (1.719–4.691) | <0.001 | 1.72 (1.053–2.794) | 0.030 |
Albumin (per 1 g/dl) | 0.71 (0.470–1.055) | 0.089 | 0.51 (0.311–0.845) | 0.009 | 1.00 (0.656–1.524) | 0.998 |
Values are presented as mean±standard deviation or median (interquartile range). IDH: intradialytic hypotension; SOFA: Sequential Organ Failure Assessment.
CI: confidence interval; SOFA: Sequential Organ Failure Assessment.
IDH: intradialytic hypotension; OR: odds ratio; CI: confidence interval; SOFA: Sequential Organ Failure Assessment. Adjusted for age, sex, septic acute kidney injury, systolic blood pressure, pulse rate, urine output, mechanical ventilation, use of vasopressors, SOFA score, Charlson comorbidity index, hemoglobin, platelet, total bilirubin, and albumin; IDH was defined as a discontinuation of dialysis because of hemodynamic instability plus a nadir systolic blood pressure <90 mm Hg (IDH-A) or a decrease in systolic blood pressure ≥30 mm Hg (IDH-B).
IDH: intradialytic hypotension; OR: odds ratio; CI: confidence interval. IDH was defined as a discontinuation of dialysis because of hemodynamic instability plus a nadir systolic blood pressure <90 mm Hg (IDH-A) or a decrease in systolic blood pressure ≥30 mm Hg (IDH-B).