The relationship between intradialytic hypotension and vascular calcification in hemodialysis patients

• Published in: PloS one 2017-10, Vol.12 (10), p.e0185846-e0185846
• Main Authors: Cho, AJin, Lee, Young-Ki, Oh, Jieun, Yoon, Jong-Woo, Shin, Dong Ho, Jeon, Hee Jung, Choi, Myung-Jin, Noh, Jung-Woo
• Format: Article
• Language: English
• Subjects: Abdomen; Aged; Aorta; Aorta - pathology; Biology and Life Sciences; Blood; Blood pressure; Blood vessels; Calcification; Calcification (ectopic); Calcification (Physiology); Calcium; Cardiovascular disease; Cardiovascular diseases; Causes of; Comparative analysis; Complications and side effects; Coronary vessels; Diabetes; Diabetes mellitus; Dialysis; Family medical history; Female; Health risks; Heart; Hemodialysis; Hospitals; Humans; Hypotension; Hypotension - complications; Internal medicine; Kidney diseases; Male; Medicine; Medicine and Health Sciences; Middle Aged; Mortality; Multivariate analysis; Patient outcomes; Patients; Physical Sciences; Radiography; Renal Dialysis; Research and Analysis Methods; Risk factors; Structure-function relationships; Ultrafiltration; Vascular Calcification - complications
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0185846

Vascular calcification is associated with structural and functional abnormality of the heart and blood vessels. We investigated the relationship between intradialytic hypotension (IDH) and vascular calcification in hemodialysis (HD) patients, and their impacts on cardiovascular events (CVEs). We enrolled 191 maintenance HD patients who underwent plain abdomen radiography for abdominal aortic calcification score (AACS). A nadir systolic blood pressure (BP) < 90 mm Hg or the requirement of bolus fluid administration was required to quantify the hypotension diagnosis. IDH was defined as > 2 hypotension episodes during 10 HD treatments. Among the 191 patients, IDH occurred in 32. AACS was higher in the IDH group compared with the no-IDH group (8.4 ± 6.0 vs. 4.9 ± 5.2, respectively; P = 0.001). High AACS was an independent risk factor after adjustment for age, diabetes mellitus, ultrafiltration, diastolic BP, and calcium level (odds ratio (OR) = 1.09, 95% CI = 1.01-1.18; P = 0.03). Patients with both IDH and AACS ≧ 4 had the highest cumulative CVE rate (27.9%, P = 0.008) compared with 11.2%, 12.5%, and 6% for those with AACS ≧ 4 only, with IDH only, and neither, respectively. In multivariate analysis, the presence of both IDH and AACS ≧ 4 was a significant predictor of CVE (hazard ratio (HR) = 2.84, 95% CI = 1.04-7.74, P = 0.04). IDH is associated with abdominal aortic calcification and is an independent risk factor for IDH. Both IDH and high AACS were significant predictors of CVE.