Risk Factors Associated with Intradialytic Hypotension among Patients with Stage 5 Chronic Kidney Disease on Hemodialysis at a Tertiary Referral Hospital in Banjarmasin Indonesia: A Retrospective Cross-sectional Study
Keywords:
CKD, hemodialysis, BMI
Abstract
Background: Intradialytic hypotension (IDH) remains one of the most frequent acute complications of maintenance hemodialysis. Local data from Indonesian hemodialysis units remain limited, although patient characteristics, dialysis practices, comorbidity burden, and nutritional status may influence IDH risk.
Methods: This retrospective cross-sectional study used secondary medical record data from adult patients with stage 5 chronic kidney disease undergoing maintenance hemodialysis at Ulin General Hospital, Banjarmasin, Indonesia. Patient-related and dialysis-related factors were evaluated. Variables with p<0.25 in bivariate analysis entered a multivariable binary logistic regression model.
Results: A total of 145 patients were included. IDH occurred in 72 patients (49.66%). In multivariable analysis, age >=60 years was associated with higher odds of IDH compared with age <60 years (adjusted prevalence odds ratio [aPOR] 3.537, 95% confidence interval [CI] 1.185-10.562, p=0.024). Compared with body mass index (BMI) >=30 kg/m2, BMI 23.0-24.9 kg/m2 was associated with lower odds of IDH (aPOR 0.101, 95% CI 0.015-0.677, p=0.018).
Conclusions: Nearly half of CKD-5HD patients experienced IDH. Older age, BMI category, antihypertensive medication burden, and pre-hemodialysis blood pressure category were associated with IDH. These findings support structured IDH risk assessment in routine hemodialysis care, especially among older patients and patients with severe pre-hemodialysis hypertension.
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References
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21. Assimon MM, Brookhart MA, Fine JP, Heiss G, Layton JB, Flythe JE. A comparative study of carvedilol versus metoprolol initiation and 1-year mortality among individuals receiving maintenance hemodialysis. Am J Kidney Dis. 2018;72(3):337–348. doi:10.1053/j.ajkd.2018.02.350
22. Chang TI, Tatoian ET, Montez-Rath ME, Chertow GM. Timing of antihypertensive medications on key utcomes in hemodialysis: a cluster randomized trial. Kidney360. 2021;2(11):1752–1760. doi:10.34067/kid.0001922021
23. Kora M, Tawfeek A, El-Zorkany K, Abd El-Mohsen AH. The relationship between hypoalbuminemia and intradialytic hypotention in haemodialysis patients. J Kidney. 2018;4(1):1000165. doi:10.4172/2472-1220.1000165
24. Hara T, Kasahara Y, Nakagawa T. Association between haemoglobin concentration and intradialytic hypotension in patients undergoing maintenance haemodialysis: a retrospective cohort study. BMJ Open. 2022;12(8):e064026. doi:10.1136/bmjopen-2022-064026
25. Keane DF, Raimann JG, Zhang H, Willetts J, Thijssen S, Kotanko P. The time of onset of intradialytic hypotension during a hemodialysis session associates with clinical parameters and mortality. Kidney Int. 2021;99(6):1408–1417. doi:10.1016/j.kint.2021.01.018
2. PERNEFRI. Indonesian Renal Registry. 13th Annual Report of Indonesian Renal Registry 2020. 2020.
3. Kuipers J, Verboom LM, Ipema KJR, Paans W, Krijnen WP, Gaillard CAJM, et al. The prevalence of intradialytic hypotension in patients on conventional hemodialysis: A systematic review with meta-analysis. Am J Nephrol. 2019 May;49(6):497–506. doi:10.1159/000500877
4. Kanbay M, Ertuglu LA, Afsar B, Ozdogan E, Siriopol D, Covic A, et al. An update review of intradialytic hypotension: concept, risk factors, clinical implications and management. Clin Kidney J. 2020;13(6):981–93. doi:10.1093/ckj/sfaa078
5. Davenport A. Why is intradialytic hypotension the commonest complication of outpatient dialysis treatments? Kidney Int RepRep. 2022;8(3):405–18. doi:10.1016/j.ekir.2022.10.031
6. Hamrahian SM, Vilayet S, Herberth J, Fülöp T. Prevention of intradialytic hypotension in hemodialysis patients: Current challenges and future prospects. Int J Nephrol Renov Dis. 2023 Aug;16:173–81. doi:10.2147/ijnrd.s245621
7. Flythe JE, Chang TI, Gallagher MP, Lindley E, Madero M, Sarafidis PA. Blood pressure and volume management in dialysis: conclusions from a KDIGO Controversies Conference. Kidney Int. 2020;97(5):861–876. doi:10.1016/j.kint.2020.01.046
8. Doulton T, Adam M, Durman K, Fan SLS, Forbes A, Jenkinson E. Management of blood pressure in adults, children and young people on dialysis: UK Kidney Association clinical practice guideline. BMC Nephrol. 2025;26(1):532. doi:10.1186/s12882-025-04451-2
9. Hara T, Kasahara Y, Nakagawa T. Pre-dialysis diastolic blood pressure and intradialytic hypotension in patients undergoing maintenance haemodialysis. J Nephrol. 2022;35(5):1419–1426. doi:10.1007/s40620-022-01292-2
10. Chen TY, Hsieh MHC, Su FY, Li CY, Wang MC, Tseng CC. Risk of intradialytic hypotension among different antihypertensives in haemodialysis patients. Clin Kidney J. 2025;18(6):sfaf159. doi:10.1093/ckj/sfaf159
11. Lv J, Tian G, Chen J, Cong Y, Luo M, Lu X. Risk factors for the development of intradialytic hypotension in patients undergoing maintenance hemodialysis. Int Urol Nephrol. 2025;57(12):4325–32. doi:10.1007/s11255-025-04645-5
12. Kurniaatmaja ER, Afiatin. Hipotensi intradialisis dan faktor-faktor risikonya pada pasien PGK derajat 5 dengan dialisis di RSUP Dr Hasan Sadikin. 2018;
13. Said FH, Chamba NG, Howlett WP, Kilonzo KG. Recurrent intradialytic hypotension, associated risk factors, and outcomes in Northern Tanzania: a retrospective cohort study. Heal Sci Rep. 2025;8(4):e70661. doi:10.1002/hsr2.70661
14. Halle MP, Hilaire D, Francois KF, Denis T, Hermine F, Gloria AE. Intradialytic hypotension and associated factors among patients on maintenance hemodialysis: a single-center study in Cameroon. Saudi J Kidney Dis Transpl. 2020;31(1):215–223. doi:10.4103/1319-2442.279944
15. Yu J, Chen X, Li Y, Wang Y, Liu Z, Shen B. High ultrafiltration rate induced intradialytic hypotension is a predictor for cardiac remodeling: a 5-year cohort study. Ren Fail. 2021;43(1):40–48. doi:10.1080/0886022x.2020.1853570
16. Deng F, Di W, Ma Y, Li Y, Liao T, Mou J. The relationship between prescription of ultrafiltration and intradialytic hypotension in Chinese hemodialysis patients. Ann Palliat Med. 2021;10(5):5316–5321. doi:10.21037/apm-21-791
17. Tjempakasari A, Prasanta N, Aditiawardana C, M.E. Correlation between interdialytic weight gain and intradialytic hypotension in patients with chronic kidney disease undergoing hemodialysis in tertiary referral hospital. Biomol Heal Sci J. 2024;7(2):109–113. doi:10.4103/bhsj.bhsj_15_24
18. Mizuiri S, Nishizawa Y, Doi T, Okubo A, Morii K, Yamashita K. Associations between body composition and intradialytic hypotension, and between intradialytic hypotension and prognosis, in hemodialysis patients. Ren Replace Ther. 2024;10:1–8. doi:10.1186/s41100-024-00550-2
19. Tian M, Zha Y, Qie S, Lin X, Yuan J. Association of body composition and intradialytic hypotension in hemodialysis patients. Blood Purif. 2020;49(3):334–340. doi:10.1159/000504245
20. Son HE, Ryu JY, Lee K, Choi YI, Kim MS, Park I. The importance of muscle mass in predicting intradialytic hypotension in patients undergoing maintenance hemodialysis. Kidney Res Clin Pr. 2022;41(5):611–622. doi:10.23876/j.krcp.21.153
21. Assimon MM, Brookhart MA, Fine JP, Heiss G, Layton JB, Flythe JE. A comparative study of carvedilol versus metoprolol initiation and 1-year mortality among individuals receiving maintenance hemodialysis. Am J Kidney Dis. 2018;72(3):337–348. doi:10.1053/j.ajkd.2018.02.350
22. Chang TI, Tatoian ET, Montez-Rath ME, Chertow GM. Timing of antihypertensive medications on key utcomes in hemodialysis: a cluster randomized trial. Kidney360. 2021;2(11):1752–1760. doi:10.34067/kid.0001922021
23. Kora M, Tawfeek A, El-Zorkany K, Abd El-Mohsen AH. The relationship between hypoalbuminemia and intradialytic hypotention in haemodialysis patients. J Kidney. 2018;4(1):1000165. doi:10.4172/2472-1220.1000165
24. Hara T, Kasahara Y, Nakagawa T. Association between haemoglobin concentration and intradialytic hypotension in patients undergoing maintenance haemodialysis: a retrospective cohort study. BMJ Open. 2022;12(8):e064026. doi:10.1136/bmjopen-2022-064026
25. Keane DF, Raimann JG, Zhang H, Willetts J, Thijssen S, Kotanko P. The time of onset of intradialytic hypotension during a hemodialysis session associates with clinical parameters and mortality. Kidney Int. 2021;99(6):1408–1417. doi:10.1016/j.kint.2021.01.018
Published
2026-08-24
How to Cite
1.
Centora A, Kurniaatmaja E, Fajari N, Prenggono M, Bakhriansyah M. Risk Factors Associated with Intradialytic Hypotension among Patients with Stage 5 Chronic Kidney Disease on Hemodialysis at a Tertiary Referral Hospital in Banjarmasin Indonesia: A Retrospective Cross-sectional Study. inakidney [Internet]. 24Aug.2026 [cited 25Aug.2026];3(2):229-35. Available from: https://inakidneyhypertension.co.id/index.php/inakidney/article/view/272
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