Frequency and Risk Factors for Intradialytic Hypotension in Patients Undergoing Maintenance Hemodialysis

Abstract

Hemodialysis (HD) patients and providers have long struggled with intra-dialytic hypotension (IDH), a complication that continues to challenge the safety and effectiveness of HD. IDH is associated with chronic end-organ damage and remains an independent risk factor for mortality among HD patients. Persistent hemodynamic instability may also accelerate the decline of residual renal function, further worsening clinical outcomes. Because individuals on dialysis already face markedly increased cardiovascular mortality and morbidity, identifying the prevalence and contributing factors of IDH has become an important clinical and academic priority. This observational study was carried out in the Hemodialysis Unit of Nepal Medical College and Teaching Hospital over one year (Baishakh 2079 to Chaitra 2079 B.S, April 2022 to March 2023 AD) without interventions or the collection of patient material. Ethical approval was obtained from the Institutional Review Committee. During each dialysis session, patients were assessed for pre- and post-dialysis weight, blood pressure, and heart rate at multiple intervals, ultrafiltration volume, and any clinical events or medical interventions related to intra-dialytic hypotension. A total of 110 patients participated, contributing 5,232 dialysis sessions. The incidence of IDH varied widely depending on the definition used, measuring 14.47% and 9.42% under stricter criteria, and rising to 62.8% with a more liberal definition. Although HD remains a widely used and generally safe modality, complications such as IDH persist and can be life-threatening. As complications and their associated factors continue to change over time, a more vigilant and systematic approach is needed to identify, monitor, and address them effectively. This highlights the need for ongoing evaluation in HD practice.