Academic Editor: Peter A. McCullough
Intradialytic hypotension (IDH) is a sudden and often serious complication of
chronic hemodialysis (HD). In this prospective study, we aimed at evaluating the
clinical predictors of IDH in a homogeneous cohort of chronic HD patients, with a
particular focus on marinobufagenin (MBG), an endogenous cardiotonic steroid
which alterations have previously been involved in various cardiovascular
disorders. MBG levels in HD patients were significantly higher than in controls
(p = 0.03), remained unchanged throughout a single HD session and were
not correlated with the absolute or partial fluid loss achieved. During a 30-day
follow-up, 19 patients (65.5%) experienced at least one IDH (73 total episodes).
An inverse correlation was found between baseline MBG and the number of IDH (R =
–0.55; p = 0.001). HD patients experiencing IDH presented remarkably
lower baseline MBG as compared to others (p = 0.008) with a
statistically significant trend during HD (p = 0.02). At Kaplan-Meier
analyses, HD patients with lower MBG manifested a four-to-six fold increased risk
of IDH during follow-up (crude Hazard Ratio ranging from 4.37 to 6.68). At Cox
regression analyses, MBG measurement at different time points resulted the
strongest time-dependent predictors of IDH among all the variables considered (HR
ranging from 0.068 to 0.155; p: 0.002 to