Recurrent Intradialytic Hypotension, Associated Risk Factors, and Outcomes in Northern Tanzania: A Retrospective Cohort Study.

BACKGROUND AND AIMS: Intradialytic hypotension (IDH) is a common phenomenon during hemodialysis (HD), with profound complications and all-cause mortality. Data on IHD is scarce in Sub-Saharan Africa. The study aimed to evaluate the incidence, risk factors, and outcome associated with recurrent IDH among patients on maintenance HD.

METHODS

This was a retrospective cohort study conducted at the Kilimanjaro Christian Medical Centre HD unit between August 1, 2021 and July 31, 2022. In the study, 39 met the inclusion criteria, and a total of 4706 HD sessions were analyzed. The predictor was the occurrence of recurrent IDH. The outcomes were mortality from IDH, hospital admission due to IDH, and termination of the respective HD session. Descriptive statistics for categorical and continuous variables. A χ 2 test was used to identify associations, and the receiver operating characteristics curve was used to determine the cutoff threshold for different parameters in determining risk factors for recurrent IDH.

RESULTS

The incidence of IDH was 4.35%; 46.3% of these IDH episodes were recurrent. Risk of IDH was higher in patients with pre-dialytic serum inorganic phosphate levels > 1.8 mmol/L (RR: 2.33, 95% CI: 1.02-5.35, p < 0.001) with a predicted threshold of 1.27 mmol/L by ROC curve (AUC 0.618, CI: 0.541-0.694, sensitivity 60%, specificity 40%), among males (aRR: 9.65, CI: 2.27-40.85, p = 0.002). A systolic blood pressure of < 140 mmHg had a significant protective effect (aRR: 0.34, CI: 0.17-0.69, p = 0.003).

CONCLUSION

Recurrent IDH is more common in males, among patients with hyperphosphatemia, and shows seasonal variations. Systolic blood pressure of < 140 mmHg confers a protective effect against recurrent IDH.