The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis

A. Tislér, Katalin Akócsi, Béla Borbás, László Fazakas, Sándor Ferenczi, Sándor Görögh, Imre Kulcsár, Lajos Nagy, József Sámik, János Szegedi, Eszter Tóth, Gyula Wágner, István Kiss

Research output: Contribution to journalArticle

106 Citations (Scopus)

Abstract

Background. While frequent or occasional symptomatic intradialytic hypotension (IDH) may influence patient well-being, its effects on survival-independent of comorbidities-has not previously been investigated. In this study, therefore, our objective was to assess the effect of frequent IDH (f-IDH) or occasional IDH (o-IDH) on survival. Methods. During a 10 month run-in period in 1998, 77 patients with f-IDH (≥10 hypotensive events/10 months, responding only to medical intervention) and 101 patients with o-IDH (1 or 2 events/10 months) were identified among all 958 patients of a dialysis network. Eighty-five patients who had no hypotensive episodes (no-IDH) during this run-in phase served as controls. Patients were followed for a median of 27 months (range: 0.3-37) and survival of patients in the three groups was compared by log-rank test. Independent association of f-IDH and o-IDH with survival, compared with no-IDH, was assessed by a proportional hazards model that included patient demographics, laboratory data and antihypertensive medication as well as comorbidity. Results. Forty-five patients (58%) with f-IDH, 47 (47%) with o-IDH and 33 (39%) with no-IDH died during the follow-up. Mortality rates (deaths/100 patient years) were 37 (log-rank P=0.013 vs no-IDH), 26 (log-rank P = 0.375 vs no-IDH) and 21 in the three groups, respectively. This indicates significantly decreased survival in patients with f-IDH as compared to those with no-IDH. In multivariate proportional hazards regression, however, where age, sex, time spent on dialysis, presence of coronary heart disease, diabetes, Kt/V, albumin level and use of β-blockers, calcium-channel blockers and long-acting nitrates has been adjusted for, neither f-IDH nor o-IDH was associated -with survival. Conclusions. Mortality in patients with f-IDH is significantly higher than in those without such events. After adjustments for covariates, however, there is no independent effect of frequent or occasional episodes of IDH on mortality.

Original languageEnglish
Pages (from-to)2601-2605
Number of pages5
JournalNephrology Dialysis Transplantation
Volume18
Issue number12
DOIs
Publication statusPublished - Dec 2003

Fingerprint

Hypotension
Renal Dialysis
Dialysis
Maintenance
Survival
Mortality
Comorbidity
Calcium Channel Blockers
Proportional Hazards Models
Nitrates
Antihypertensive Agents
Coronary Disease
Albumins
Demography

Keywords

  • Clinical study
  • Cohort study
  • Comorbidity
  • Haemodialysis-complication
  • Hypotension
  • Survival

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Cite this

The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis. / Tislér, A.; Akócsi, Katalin; Borbás, Béla; Fazakas, László; Ferenczi, Sándor; Görögh, Sándor; Kulcsár, Imre; Nagy, Lajos; Sámik, József; Szegedi, János; Tóth, Eszter; Wágner, Gyula; Kiss, István.

In: Nephrology Dialysis Transplantation, Vol. 18, No. 12, 12.2003, p. 2601-2605.

Research output: Contribution to journalArticle

Tislér, A, Akócsi, K, Borbás, B, Fazakas, L, Ferenczi, S, Görögh, S, Kulcsár, I, Nagy, L, Sámik, J, Szegedi, J, Tóth, E, Wágner, G & Kiss, I 2003, 'The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis', Nephrology Dialysis Transplantation, vol. 18, no. 12, pp. 2601-2605. https://doi.org/10.1093/ndt/gfg450
Tislér, A. ; Akócsi, Katalin ; Borbás, Béla ; Fazakas, László ; Ferenczi, Sándor ; Görögh, Sándor ; Kulcsár, Imre ; Nagy, Lajos ; Sámik, József ; Szegedi, János ; Tóth, Eszter ; Wágner, Gyula ; Kiss, István. / The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis. In: Nephrology Dialysis Transplantation. 2003 ; Vol. 18, No. 12. pp. 2601-2605.
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T1 - The effect of frequent or occasional dialysis-associated hypotension on survival of patients on maintenance haemodialysis

AU - Tislér, A.

AU - Akócsi, Katalin

AU - Borbás, Béla

AU - Fazakas, László

AU - Ferenczi, Sándor

AU - Görögh, Sándor

AU - Kulcsár, Imre

AU - Nagy, Lajos

AU - Sámik, József

AU - Szegedi, János

AU - Tóth, Eszter

AU - Wágner, Gyula

AU - Kiss, István

PY - 2003/12

Y1 - 2003/12

N2 - Background. While frequent or occasional symptomatic intradialytic hypotension (IDH) may influence patient well-being, its effects on survival-independent of comorbidities-has not previously been investigated. In this study, therefore, our objective was to assess the effect of frequent IDH (f-IDH) or occasional IDH (o-IDH) on survival. Methods. During a 10 month run-in period in 1998, 77 patients with f-IDH (≥10 hypotensive events/10 months, responding only to medical intervention) and 101 patients with o-IDH (1 or 2 events/10 months) were identified among all 958 patients of a dialysis network. Eighty-five patients who had no hypotensive episodes (no-IDH) during this run-in phase served as controls. Patients were followed for a median of 27 months (range: 0.3-37) and survival of patients in the three groups was compared by log-rank test. Independent association of f-IDH and o-IDH with survival, compared with no-IDH, was assessed by a proportional hazards model that included patient demographics, laboratory data and antihypertensive medication as well as comorbidity. Results. Forty-five patients (58%) with f-IDH, 47 (47%) with o-IDH and 33 (39%) with no-IDH died during the follow-up. Mortality rates (deaths/100 patient years) were 37 (log-rank P=0.013 vs no-IDH), 26 (log-rank P = 0.375 vs no-IDH) and 21 in the three groups, respectively. This indicates significantly decreased survival in patients with f-IDH as compared to those with no-IDH. In multivariate proportional hazards regression, however, where age, sex, time spent on dialysis, presence of coronary heart disease, diabetes, Kt/V, albumin level and use of β-blockers, calcium-channel blockers and long-acting nitrates has been adjusted for, neither f-IDH nor o-IDH was associated -with survival. Conclusions. Mortality in patients with f-IDH is significantly higher than in those without such events. After adjustments for covariates, however, there is no independent effect of frequent or occasional episodes of IDH on mortality.

AB - Background. While frequent or occasional symptomatic intradialytic hypotension (IDH) may influence patient well-being, its effects on survival-independent of comorbidities-has not previously been investigated. In this study, therefore, our objective was to assess the effect of frequent IDH (f-IDH) or occasional IDH (o-IDH) on survival. Methods. During a 10 month run-in period in 1998, 77 patients with f-IDH (≥10 hypotensive events/10 months, responding only to medical intervention) and 101 patients with o-IDH (1 or 2 events/10 months) were identified among all 958 patients of a dialysis network. Eighty-five patients who had no hypotensive episodes (no-IDH) during this run-in phase served as controls. Patients were followed for a median of 27 months (range: 0.3-37) and survival of patients in the three groups was compared by log-rank test. Independent association of f-IDH and o-IDH with survival, compared with no-IDH, was assessed by a proportional hazards model that included patient demographics, laboratory data and antihypertensive medication as well as comorbidity. Results. Forty-five patients (58%) with f-IDH, 47 (47%) with o-IDH and 33 (39%) with no-IDH died during the follow-up. Mortality rates (deaths/100 patient years) were 37 (log-rank P=0.013 vs no-IDH), 26 (log-rank P = 0.375 vs no-IDH) and 21 in the three groups, respectively. This indicates significantly decreased survival in patients with f-IDH as compared to those with no-IDH. In multivariate proportional hazards regression, however, where age, sex, time spent on dialysis, presence of coronary heart disease, diabetes, Kt/V, albumin level and use of β-blockers, calcium-channel blockers and long-acting nitrates has been adjusted for, neither f-IDH nor o-IDH was associated -with survival. Conclusions. Mortality in patients with f-IDH is significantly higher than in those without such events. After adjustments for covariates, however, there is no independent effect of frequent or occasional episodes of IDH on mortality.

KW - Clinical study

KW - Cohort study

KW - Comorbidity

KW - Haemodialysis-complication

KW - Hypotension

KW - Survival

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U2 - 10.1093/ndt/gfg450

DO - 10.1093/ndt/gfg450

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