Aim: IntraDialysis Hypotension (IDH) is still one of the main hemodialysis related complications. The patient’s peculiar reaction to the treatment implies difficulties in preventing IDH. This work is aimed at defining an index to quantify the risk of IDH at the beginning of each session through a multivariate analysis of clinical data.
Methods: Data referring to 516 sessions performed on 50 patients enrolled at A. Manzoni Hospital Lecco, Italy and 20 patients at Regional Hospital of Lugano, Switzerland were collected. Clinical prescriptions, hydration status, dialysis machine and hematochemical data were recorded and stored in a unique flexible structured database.
Patients suffering from IDH in 2 or more sessions were classified as Hypotension Prone (HP), the others as Hypotension Resistant (HR). Statistical analysis was performed to identify the potential risk factor related to IDH onset.
A new index, J, was defined as a weighted patient-specific combination of the statistically relevant parameters and calculated for each session of each patient. The weight of the index coefficients can be dynamically adjourned based on the longitudinal analysis of the parameters. J>1 points out the risk of IDH. J prediction accuracy was quantified as the percentage number of predicted IDH events versus the total number of IDHs.
Results: Initial values of potassium concentration, systolic and diastolic blood pressure, and weight gain from the end of the previous treatment result to be statistically different between HP and HR patients. J allows recognising the 96% of the IDH episodes.
Conclusions: The evaluation of J at the beginning of the dialysis session can provide the clinician useful information about the risk to develop IDH during the treatment and can advise physicians about the need to modify the prescription
