The EFFECT OF PULMONARY HYPERTENSION ON INTRADIALYTIC HYPOTENSION AMONG PATIENTS WITH END STAGE RENAL DISEASE

Abstract

Background: Intradialytic hypotension (IDH) is an important problem in end stage renal disease (ESRD). Therefore, this study aimed to assess the effect of pulmonary hypertension (PHT) on IDH among patients with ESRD using transthoracic echocardiography. Methods: In this prospective etiognostic study, transthoracic echocardiography was performed among patients with ESRD in Burapha University Hospital, Thailand. The hemodialytic flow chart data of patients in the hemodialysis unit was collected to ascertain whether these patients presented IDH. The baseline clinical hemodialysis profiles and echocardiographic findings were analyzed using univariate predictors of IDH. Multivariate logistic regression was used to identify independent predictors of IDH. Results: A total of 35 patients with ESRD were enrolled between June 2020 and March 2021. Of these, 16 had PHT (45.7%). The prevalence of IDH was 48.5%. All patients exhibited a normal left ventricular ejection fraction. No significant difference was observed of RVSP between frequent-IDH group and occasional-IDH group (45.33 ± 11.62 mmHg and 41.06 ± 13.78 mmHg, respectively, p=0.401). Using univariate analysis, being female, left ventricular mass index, left ventricular ejection fraction and PHT were significantly associated with IDH. No factors were indicated related to IDH occurrence using multivariate analysis. Nevertheless, female patients with ESRD presenting PHT illustrated a tendency to have IDH. This was evidenced by the risk ratio of being female and patients with PHT being 3.13 (95% CI: 0.74-13.30) and 2.18 (95% CI: 0.34-7.06), respectively. Conclusion: Patients with ESRD presenting PHT showed a higher tendency of developing IDH during hemodialysis than patients with ESRD without PHT. The difference however was statistically insignificant.