A Clinical Prediction Score for Intradialytic Hypotension Among Hospitalized Patients with Acute Kidney Injury.

 

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https://storage.unitedwebnetwork.com/files/1099/749a8ba9ec4928ca5fdc85516070a8bc.pdf
A Clinical Prediction Score for Intradialytic Hypotension Among Hospitalized Patients with Acute Kidney Injury.

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Suthiya
Anumas
Suthiya Anumas beausuth26@gmail.com Thammasat University Internal of Medicine Pathumthani Thailand *
Piyanet Suwanin piyanet.su@hotmail.com Thammasat University Internal of Medicine Pathumthani Thailand -
Pattharawin Pattharanitima pattharawin@hotmail,com Thammasat University Internal of Medicine Pathumthani Thailand -
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Intradialytic hypotension (IDH) in hospitalized patients with acute kidney injury (AKI) is associated with increased morbidity and mortality rates. Therefore, accurately identifying risk factors and implementing prevention strategies are essential. This study aims to investigate the risk factors associated with IDH in hospitalized patients with AKI and develop an accurate prediction model to assess IDH risk in this setting.

This retrospective cohort study included hospitalized patients with AKI who required conventional renal replacement therapy (RRT) at Thammasat university hospital, Thailand between January 1st, 2024 and December 31st, 2024. Multiple logistic regression was performed to identify risk factors. The area under the receiver operating characteristic curve (AUROC) was used to evaluate the performance of the score. 

Among 85 patients, data from a total of 423 hemodialysis sessions were analyzed. The median age was 61 years, and 61.2% had a history of HT. The most common cause of AKI was sepsis and the incidence of IDH was 35.9%. Multiple logistic regression identified risk factors associated with an increased risk of IDH, including residual urine output <100 ml/day (OR 1.75, p=0.02), administration of inotropic drugs (OR 3.19, p<0.001), previous history of IDH (OR 2.40, p=0.001), and pre-dialysis MAP (MAP 80-90 mmHg, OR 2.51, p=0.002 and MAP <80, OR 3.29, p<0.001). In contrast, history of hypertension was associated with a decreased risk (OR 0.57, p=0.02). To develop a predictive score for IDH, a weighted integer-based model was constructed from these factors and categorized patients into three risk groups: low-risk (score ≤1), intermediate-risk (score 2-3), and high-risk (score >3) associated with IDH incidences of 13.82, 30.3, and 55.9%, respectively. The model demonstrated an area under the curve (AUROC) of 0.759 (95% CI: 0.712–0.806), indicating good predictive performance.

The predictive score for IDH demonstrated good performance and highlights the importance of raising awareness to guide interventions aimed at improving the outcomes of hospitalized AKI patients requiring conventional RRT.

During the preparation of this work, the author(s) used ChatGPT-5.0 to check grammar. After using this tool, the author(s) reviewed and edited the content as needed and take full responsibility for the final content of the publication.

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