The relationships between intradialytic hypotension and estimated peak oxygen uptake or heart rate recovery after exercise

Abstract

We investigated the relationships between intradialytic hypotension (IDH) and estimated peak oxygen uptake (peak VO₂) or heart rate recovery after exercise (HRR), and whether the latter two parameters are useful indicators of IDH. We enrolled 216 hemodialysis patients who underwent cardiac stress tests using a bicycle ergometer. IDH was defined as when a patient required treatment for hypotension during hemodialysis. Compared with the non-IDH group, the IDH group had lower estimated peak VO₂ and HRR values (p<0.001). After adjusting for the serum albumin level, cardiac function, and risk factors for arteriosclerosis, estimated peak VO₂ (odds ratio [OR]: 0.80, p=0.001, 95% confidence interval [CI]: 0.70 to 0.91) and HRR (OR: 0.91, p=0.009, 95%CI: 0.85 to 0.98) remained significant risk factors for IDH. The optimal cut-off point for estimated peak VO₂ was 13.8 mL/kg/min (sensitivity: 0.86, specificity: 0.69, p<0.001), and that for HRR was 7 beats (sensitivity: 0.80, specificity: 0.62, p<0.001). Thus, we concluded that estimated peak VO₂ and HRR are independent risk factors for and useful indicators of IDH because the obtained cut-off points for these parameters were highly accurate predictors of IDH.