High ultrafiltration rate induced intradialytic hypotension is a predictor for cardiac remodeling: a 5-year cohort study

Figures & data

Table 1. Demographic, clinical and biochemical data of the patients.

Characteristics	Total (n = 209)	no-IDH (n = 113)	IDH (n = 96)	p value
Age, years	56.06 ± 13.87	52.63 ± 13.42	60.29 ± 13.31	<.001
Male	118 (60.2%)	81 (71.7%)	37 (44.6%)	<.001
Normalized ultrafiltration rate, ml/h/kg	10.69 ± 4.14	9.65 ± 4.33	11.97 ± 3.50	<.001
IDWG, kg	3.85 ± 1.58	3.43 ± 1.65	4.35 ± 1.33	<.001
Preserved residual kidney function	41 (20.9%)	35 (31%)	6 (7.2%)	<.001
Duration of dialysis, months	30.57 ± 38.25	30.69 ± 41.11	30.41 ± 34.20	.953
Dry weight, kg	58.67 ± 10.81	59.44 ± 10.16	57.73 ± 11.56	.259
spKt/Vurea	1.53 ± 0.63	1.57 ± 0.71	1.48 ± 0.53	.405
BMI, kg/m^2	22.32 ± 4.01	21.67 ± 3.68	23.20 ± 4.29	.008
Serum albumin, g/L	39.14 ± 3.54	38.90 ± 3.78	39.42 ± 3.25	.342
Serum creatinine, μmol/L	995.30 ± 286.09	974.28 ± 298.93	1022.81 ± 267.71	.251
Hemoglobin, g/L	102 ± 25.24	99.28 ± 29.06	105.70 ± 18.39	.745
NT-proBNP, pg/mL	5051.94 ± 5472.11	4660.82 ± 5266.30	5547.72 ± 5721.52	.309
iPTH, ng/L	435.05 ± 462.15	393.52 ± 375.44	486.04 ± 548.57	.187
Serum β2MG, mg/L	29.36 ± 12.59	30.58 ± 11.96	27.88 ± 13.24	.176
hs CRP, mg/L	7.15 ± 12.26	7.62 ± 13.22	6.62 ± 11.15	.590
Predialysis-SBP, mmHg	136.63 ± 17.67	139.27 ± 13.19	133.52 ± 21.46	.019
Predialysis-DBP, mmHg	82.44 ± 10.81	84.47 ± 9.21	80.06 ± 12.05	.003
Postdialysis-SBP, mmHg	125.46 ± 19.26	133.3 ± 15.9	116.14 ± 18.81	<.001
Postdialysis-DBP, mmHg	78.45 ± 10.44	82.46 ± 8.37	73.68 ± 10.69	<.001
EF, %	63.18 ± 9.25	63.22 ± 7.69	63.13 ± 11.47	.962
LADI, mm/m^2	24.91 ± 4.17	24.55 ± 4.32	25.49 ± 3.91	.238
RWT	0.46 ± 0.12	0.44 ± 0.80	0.49 ± 0.16	.057
LVMI, g/m^2.7	47.33 ± 18.62	47.67 ± 16.07	46.92 ± 21.38	.798
Antihypertensive medication dosage, tablets	2.39 ± 1.80	2.32 ± 1.80	2.54 ± 1.84	.612
Antihypertensive medication type	1.98 ± 1.34	1.95 ± 1.34	2.04 ± 1.34	.778
Hypertension	129 (65.8%)	75 (66.4%)	54 (65.1%)	.849
Diabetes mellitus	31 (15.8%)	15 (13.3%)	16 (19.3%)	.257
Cardiovascular disease	18 (9.2%)	12 (10.6%)	6 (7.2%)	.419
Cerebrovascular disease	3 (1.5%)	1 (0.9%)	2 (2.4%)	.393

Values are mean (SD) for continuous variables and % (n) for categorical variables.

IDWG: interdialytic weight gain; BMI: body mass index; NT-proBNP: N-terminal pro-B-type natriuretic peptide; iPTH: intact parathyroid hormone; β₂MG: β₂-microglobulin; hs-CRP: high-sensitive c-reactive protein; EF: ejection fraction; LADI: left atrium diameter index; RWT: relative wall thickness; LVMI: left ventricular mass index; Preserved residual kidney function: 24 h urine output over 100 mL.

Figure 1. Kaplan–Meier survival curves of patients with IDH and no-IDH.

Table 2. Logistic regression models of UFR on IDH.

Model	HR	95%CI	p value
Ultrafiltration (continuous variable, per 1ml/h/kg increase)
Unadjusted	1.16	1.08–1.26	<.001
Model 1	1.24	1.12–1.39	<.001
Model 2	1.20	1.03–1.40	.017
Model 3	1.20	1.04–1.40	.016
Model 4	1.22	1.00–1.47	.042
Model 5	1.65	1.05–2.61	.031
Model 6	2.37	1.21–4.62	.012

UFR: ultrafiltration rate; IDH: intradialytic-hypotension.

Model 1: adjusted for demographic data (age, sex, and body mass index).

Model 2: adjusted for Model 1 + dialysis information (interdialytic weight gain, residual renal function, dialysis vintage and single-pool Kt/V).

Model 3: adjusted for Model 2 + comorbid conditions (history of primary hypertension, coronary heart disease, and diabetes).

Model 4: adjusted for Model 3 + biochemical data (serum albumin, pre-albumin, creatinine and hemoglobin).

Model 5: adjusted for Model 4 + cardiac conditions (NT- proBNP, left ventricular mass index, left ventricular ejection fraction, and left atrium diameter index).

Model 6: adjusted for Model 5+ predialysis blood pressure (predialysis systolic blood pressure and diastolic blood pressure).

Table 3. IDH and cardiac structural/ functional alterations.

Echocardiography parameters	Total			no-IDH			IDH
	Mean ± SD		p value	Mean ± SD		p value	Mean ± SD		p value
	recruitment period	end of the study		recruitment period	end of the study		recruitment period	end of the study
AORD, mm	32.71 ± 3.27	33.61 ± 5.07	.119	33.66 ± 3.37	34.36 ± 3.79	.271	31.45 ± 2.69	32.62 ± 6.30	.272
LAD, mm	39.95 ± 5.44	40.59 ± 7.61	.516	40.30 ± 6.39	41.27 ± 6.96	.446	39.48 ± 3.87	39.69 ± 8.40	.894
LVDD, mm	46.00 ± 6.52	50.37 ± 7.14	<.001	47.26 ± 5.94	50.59 ± 7.51	.013	44.30 ± 6.95	50.07 ± 6.68	.001
LVDS, mm	30.29 ± 5.38	31.36 ± 6.84	.256	31.20 ± 5.99	31.45 ± 6.00	.843	29.05 ± 4.19	31.24 ± 7.92	.127
IVST, mm	10.71 ± 1.83	11.00 ± 2.64	.376	10.72 ± 1.92	10.74 ± 2.06	.962	10.70 ± 1.74	11.35 ± 3.26	.272
LVPWT, mm	9.96 ± 1.51	10.53 ± 1.87	.018	9.98 ± 1.58	10.41 ± 1.71	.143	9.93 ± 1.42	10.70 ± 2.09	.062
LVEF, %	65.95 ± 7.41	63.89 ± 6.45	.068	65.47 ± 7.81	64.00 ± 6.82	.336	67.39 ± 5.72	63.55 ± 5.88	.010
LADI, mm/m^2	24.53 ± 4.10	25.38 ± 4.70	.135	24.64 ± 4.13	24.26 ± 4.43	.623	24.74 ± 3.58	26.40 ± 5.32	.015
RWT	0.43 ± 0.09	0.45 ± 0.08	.128	0.43 ± 0.09	0.44 ± 0.08	.312	0.44 ± 0.10	0.47 ± 0.09	.257
LVMI, g/m^2.7	45.21 ± 11.77	53.15 ± 19.89	.001	45.50 ± 11.88	49.28 ± 16.86	.173	44.77 ± 11.74	58.96 ± 22.75	<.001

Values are mean (SD) for continuous variables.

AoRD: aortic root inside diameter; LAD: left atrium diameter; LVDD: left ventricular end-diastolic diameter; LVDS: left ventricular end-systolic dimension; IVST: interventricular septal thickness; LVPWT: left ventricular posterior wall thickness; LVEF: left ventricular ejection fraction; LADI: left atrium diameter index; RWT: relative wall thickness; LVMI: left ventricular mass index.

Table 4. Interactions between UFR and IDH on LVMI variation.

		OR	p value
Crude model 1	IDH	0.10 (0.01 ∼ 1.32)	.080
	UFR, ml/h/kg	0.95 (0.84 ∼ 1.07)	.364
	IDH × UFR, ml/h/kg	1.33 (1.07 ∼ 1.65)	.010
Adjusted model 2	IDH	0.07 (0.00 ∼ 1.28)	.072
	UFR, ml/h/kg	0.99 (0.85 ∼ 1.15)	.875
	IDH × UFR, ml/h/kg	1.37 (1.07 ∼ 1.77)	.014

IDH: intradialytic hypotension; UFR: ultrafiltration rate; LVMI: left ventricular mass index model 2: adjusted for age, gender, body mass index, cardiovascular comorbidity (coronary heart disease and arrhythmia), ejection fraction.

Table 5. UFR and cardiac structural/ functional alterations in both groups.

Echocardiography parameters	IDH group						no-IDH group
	High-UFR			Low-UFR			High-UFR			Low-UFR
	Mean ± SD		p-value	Mean ± SD		p-value	Mean ± SD		p-value	Mean ± SD		p-value
	recruitment period	end of the study		recruitment period	end of the study		recruitment period	end of the study		recruitment period	end of the study
AORD, mm	31.00 ± 2.52	33.36 ± 3.62	.001	33.11 ± 2.76	29.89 ± 11.84	.453	33.54 ± 2.48	33.58 ± 4.77	.968	33.75 ± 3.94	34.94 ± 2.79	.135
LAD, mm	39.30 ± 3.70	41.12 ± 6.03	.167	40.11 ± 4.62	34.44 ± 13.31	.338	41.46 ± 7.53	41.33 ± 8.02	.956	39.44 ± 5.34	41.22 ± 6.19	.219
LVDD, mm	44.26 ± 6.07	50.88 ± 6.71	<.001	44.44 ± 10.08	47.00 ± 5.92	.575	47.40 ± 6.68	50.96 ± 8.86	.152	47.15 ± 5.42	50.30 ± 6.44	.034
LVDS, mm	29.13 ± 3.18	32.22 ± 6.41	.027	28.78 ± 6.96	27.78 ± 11.72	.825	31.96 ± 6.96	31.25 ± 7.18	.764	30.63 ± 5.18	31.59 ± 5.06	.476
IVST, mm	10.59 ± 1.79	11.50 ± 3.47	.205	11.11 ± 1.54	10.78 ± 2.39	.700	11.48 ± 2.10	10.32 ± 2.12	.068	10.15 ± 1.56	11.06 ± 1.98	.02
LVPWT, mm	10.00 ± 1.37	10.74 ± 1.97	.098	9.67 ± 1.66	10.56 ± 2.60	.426	10.52 ± 1.85	9.92 ± 1.66	.206	9.58 ± 1.23	10.79 ± 1.67	.001
EF, %	68.08 ± 5.84	63.28 ± 6.26	.010	65.25 ± 5.09	64.38 ± 4.81	.667	65.00 ± 9.66	63.16 ± 6.90	.52	65.82 ± 6.18	64.64 ± 6.80	.469
LADI, mm/m^2	25.28 ± 3.76	27.50 ± 5.43	.040	24.35 ± 3.75	24.36 ± 4.54	.978	25.14 ± 4.66	25.22 ± 5.27	.958	23.55 ± 3.62	24.26 ± 3.72	.398
RWT	0.43 ± 0.10	0.46 ± 0.08	.283	0.46 ± 0.10	0.49 ± 0.11	.659	0.41 ± 0.09	0.47 ± 0.09	.027	0.42 ± 0.05	0.44 ± 0.09	.285
LVMI, g/m^2.7	45.87 ± 11.03	63.67 ± 22.75	<.001	40.62 ± 14.16	41.30 ± 11.89	.889	45.96 ± 12.00	46.93 ± 19.11	.849	45.16 ± 11.97	50.99 ± 15.09	.063

Values are mean (SD) for continuous variables.

LVEF: left ventricular ejection fraction; LADI: left atrium diameter index; RWT: relative wall thickness; LVMI: left ventricular mass index; AoRD: aortic root inside diameter; LAD: left atrium diameter; LVDD: left ventricular end-diastolic diameter; LVDS: left ventricular end-systolic dimension; IVST: interventricular septal thickness; LVPWT: left ventricular posterior wall thickness.