Intradialysis hypotension in patient with end-stage renal disease on chronic haemodialysis at Kenyatta National Hospital Renal Unit
Intradialysis hypotension is a frequent complication in patients with end-stage renal disease on chronic haemodialysis. Problems associated with IDH have a negative impact on health-related quality of life. Morbidity and mortality is high in patients with f-IDH. Factors associated with IDH include: hypovolemia, ventricular dysfunction, autonomic dysfunction, electrolyte imbalance, hypoalbuminaemia, Anaemia and long duration of haemodialysis. Objective: To study factors associated with the development ofIDH in patients with ESRD on chronic haemodialysis. Design: Descriptive study. Studv population: Patients with ESRD on haemodialysis. Stud" Area: KNH renal unit. Methodologv: Files of the 90 patients on haemodialysis at KNH renal unit were scrutinized. Sixty-three with ESRD on chronic haemodialysis were identified and demographic data taken. Cause of ESRD and anti¬hypertensive medication in use was ascertained. The number of IDH events in previous three months was noted from dialysis files. Blood was taken from 50 patients who gave consent, for analysis of haemoglobin, albumin, and electrolytes during a dialysis session. Echocardiographic evaluation of LV function was done a day post dialysis. Data analysis: Data analysis was done using SPSS 11.1 (SPSS Inc. Chicago Illinois USA) statistical package. Comparison of means of continuous variables was made using student t-test, categorical variables using proportions and ratios. Association was determined using chi-square test. Results: There were 90 patients on haemodialysis during the study period, out of whom, 63(700/0) had dialyzed for =:J3months. This group on chronic haemodialysis included 38 males (60.3%) and 25 females. Nineteen (39.7%) of the patients on chronic haemodialysis met the criteria for frequent IDH. Mean age was 46.9± SD lS.8yrs for males and 40.6± SD 13.9yrs for females. Fifty of the patients on chronic haemodialysis gave consent for inclusion in the study. Diabetes was the cause ofESRD in 30% of the study patients. 88% of the study subjects had hypertension. CCB was the most commonly used anti-hypertension drug (60% of the patients). 66% of the patients had LV diastolic dysfunction. LV diastolic dysfunction was present in 73.7% of the patients with f-IDH and 6l.3% of those with occasional or no IDH (p=0.024). Mean age of patients with f-IDH and those with occasional or no IDH was 53.2±15.8 & 43.5±14.2 years respectively (P=0.029). Patients with f-IDH had low mean serum albumin than those with occasional or no IDH before and after matching for age and sex with a P value of 0.098 and 0.016 respectively. Conclusion: There was high period prevalence of f-IDH at KNH renal unit. Risk factors for f-IDH in the study population were: Older age, hypoalbuminaemia, diabetes mellitus, and L V diastolic dysfunction.