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2020년 제 71차 대한내과학회 추계학술대회
￭S-496 ￭ Serum phosphorus levels are associated with intradialytic hypotension
in hemodialysis patients
성균관대학교 삼성창원병원 내과 임덕길, 이유지, 조성, 김성록
Background/Aims: Intradialytic hypotension (IDH) is a common serious complication in hemodialysis (HD) patients.
Hyperphosphatemia is also common in HD patients and promotes vascular calcification. Given the association between vascular calcification and IDH, we sought to investigate the association between IDH and serum phosphorus levels in HD patients.
Methods: We enrolled 173 adult patients who received maintenance HD for at least 3 months or more. IDH was defined as a nadir systolic blood pressure <90 mmHg or the occurrence of a hypotension-related symptom requiring intervention, including bolus fluid administration and cessation of fluid removal, at least once during three consecutive HD treatments. Serum phosphorus levels were analyzed both as a continuous variable and as a categorical variable [< 4.0, 4.0–5.5 (reference), and ≥ 5.5 mg/dL].
Results: IDH occurred in 47 (30%) of the 173 HD patients. Mean [SD] phosphorus level was 4.9 [1.6] mg/dL. Each increase in serum phosphorus of 1 mg/dL was associated with 2.5-fold increased odds for developing IDH. The fully adjusted odds ratio (OR) and 95%
confidence intervals (CIs) were 2.51 (1.76–3.60). Serum phosphorus was significantly associated with IDH even after adjusting for ultrafiltration rate; the OR and 95% CIs were 2.50 (1.74–3.58). High categorized phosphorus levels were also associated with IDH.
Serum phosphorus ≥5.5 mg/dL was associated with 7.6-fold increased odds of developing IDH compared to serum phosphorus levels between 4.0 to <5.5 mg/dL (reference level); the fully adjusted OR and 95% CIs were 7.61 (2.76–21.03). On the other hand, serum phosphorus <4.0 was associated with decreased odds of IDH. In subgroup analyses, diabetes modified the association between IDH and phosphorus levels, with a more pronounced association in diabetic patients.
Conclusions: In HD patients, higher phosphorus levels were significantly associated with an increased occurrence of IDH. Therefore, strictly controlling phosphorus levels may be effective in reducing IDH in HD patients.
