Association of limb ischemic preconditioning with intradialytic hypotension in patients with diabetic kidney disease undergoing hemodialysis: a retrospective analysis.

OBJECTIVE

To investigate the association between limb ischemic preconditioning (LIPC) and intradialytic hypotension (IDH) in patients with diabetic kidney disease (DKD) undergoing maintenance hemodialysis (MHD).

METHODS

This single-center retrospective cohort study consecutively enrolled 112 patients with DKD receiving MHD at our institution between January and December 2023. Among them, 50 patients were assigned to the LIPC group and 62 to the control group. The incidence of IDH, blood pressure trends, clinical interventions, and the occurrence of major adverse cardiovascular events (MACE) were compared between groups. Considering the potential intra-individual correlation across repeated dialysis sessions, a generalized linear mixed model (GLMM) was used to identify independent risk factors for IDH, with each dialysis session as the unit of analysis and patient-specific random intercepts included.

RESULTS

The overall incidence of IDH in the LIPC group was 7.1% (4.7-8.8), significantly lower than 11.8% (6.6-30.0) in the control group. The frequency of IDH episodes across all time intervals (0-1 h, 1-2 h, 2-3 h, and 3-4 h) was significantly lower in the LIPC group (all P < 0.001). The reduction in systolic blood pressure was smaller in the LIPC group compared with the control group (11.2 mmHg vs. 21.4 mmHg). LIPC (odds ratio [OR] = 0.39, 95% confidence interval [CI]: 0.28-0.54) and baseline systolic blood pressure (OR = 0.98, 95% CI: 0.97-1.00) were protective factors for IDH.

CONCLUSIONS

LIPC use was associated with a significantly lower incidence of IDH in DKD patients undergoing MHD and attenuated blood pressure decline, with a favorable safety profile.