Prevalence and associated factors of intradialytic hypotension among patients with kidney failure on maintenance hemodialysis at Kiruddu National Referral Hospital, Uganda

Abstract

Background: Intradialytic hypotension (IDH), a frequent hemodialysis complication, is associated with increased morbidity, reduced quality of life, and increased mortality in patients with kidney failure. However, data on the burden and associated factors of IDH in sub-Saharan African settings, including Uganda are limited. This study determined the prevalence and associated factors of IDH among patients with kidney failure attending the dialysis unit of Kiruddu National Referral Hospital (KNRH), Uganda. Methods: A cross-sectional study enrolled adult patients (aged≥18 years) with kidney failure undergoing maintenance hemodialysis through arteriovenous fistula or a central venous access catheter at KNRH from November 2024 to January 2025. Each participant was recruited and observed only once, during a single hemodialysis session. Blood pressure (BP) was measured 5 min pre-, intra- (every 30 min), and 5 min post-dialysis. IDH was defined as per European Best Practice Guidelines (EBPG: systolic blood pressure [SBP] decrease>20 mmHg or mean arterial pressure [MAP]>10 mmHg with symptoms requiring intervention) or nadir criteria (SBP<90 mmHg). Sociodemographic, clinical, and dialysis-related data were collected using interviewer-administered questionnaire and from medical records review. We used multivariable logistic regression to identify associated factors. Results: We enrolled 186 participants with a median age of 46.5 (inter-quartile range [IQR]=34–58) years; 56.9% were male. Overall, 25 developed IDH for a prevalence of 13.4% (95% CI: 9–19%). EBPG and nadir definitions identified 18 (9.67%) and 19 (10.22%) cases of IDH, respectively. Heart failure (aOR=6.41, 95% CI: 1.29–31.77, p=0.023), diabetes mellitus (aOR=4.85, 95% CI: 1.15–20.40, p=0.031), and low hemoglobin (<6 g/dL) (aOR=6.35, 95% CI: 1.91–21.15, p=0.003) were significantly associated with IDH Conclusion: Intradialytic hypotension was relatively common at KNRH, affecting one in ten patients with kidney failure, and was significantly associated with underlying comorbidities, including heart failure, diabetes, and severe anemia. Early identification and management of these risk factors—through optimized volume status, improved glycemic control, and correction of severe anemia—may mitigate IDH episodes and enhance outcomes for patients with kidney failure on hemodialysis. Future longitudinal studies could assess clinical and prognostic implications of IDH in this setting.