ASSOCIATION BETWEEN PRE-DIALYSIS HEMOGLOBIN LEVELS AND INTRADIALYTIC HYPOTENSION IN CHRONIC HEMODIALYSIS PATIENTS

Abstract

Background: Intradialytic hypotension (IDH) is one of the most common acute complications of maintenance hemodialysis and is associated with patient discomfort, inadequate dialysis delivery, end-organ ischemia, hospitalization, and mortality. At the same time, anemia is highly prevalent in chronic kidney disease due to reduced erythropoietin production, inflammation, and iron dysregulation. The relationship between pre-dialysis hemoglobin and IDH remains clinically important because hemoglobin is a modifiable factor in routine dialysis care. Objective: To determine the association between pre-dialysis hemoglobin concentration and the occurrence of intradialytic hypotension in adult chronic hemodialysis patients. Methodology: A comparative cross-sectional study was structured around 60 adult patients receiving maintenance hemodialysis at Muhammad Salman Khalid Dialysis and Medical Complex Hospital and Bahria International Hospital, Lahore. Consecutive sampling was used. Pre-dialysis hemoglobin was recorded from same-day laboratory values. Blood pressure was observed before dialysis and at 30-minute intervals during treatment. IDH was identified from a clinically meaningful drop in systolic blood pressure with or without symptoms. Data were analyzed using descriptive statistics, independent-samples t tests, chi-square tests, and binary logistic regression. Results: Of the 61 patients, 24 (39.3%) experienced IDH. Mean pre-dialysis hemoglobin was lower in the IDH group (9.79 ± 0.96 g/dL) than in the non-IDH group (10.63 ± 0.95 g/dL). Patients with hemoglobin below 10.0 g/dL showed the highest proportion of IDH episodes. In logistic regression, pre-dialysis hemoglobin remained a significant independent predictor of IDH (OR = 0.36, 95% CI [0.18, 0.72], p = .004). Conclusion: Lower pre-dialysis hemoglobin was significantly associated with intradialytic hypotension. The findings support the importance of careful anemia assessment and individualized hemodynamic monitoring in chronic hemodialysis patients.