AUTONOMIC DYSREGULATION IN HEMODIALYSIS: DIVERGENT PREDICTORS OF HYPOTENSION AND HYPOGLYCEMIA

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https://storage.unitedwebnetwork.com/files/1099/920f5a6850c6e795c796b428fbd7596e.pdf

Abstract Title *

AUTONOMIC DYSREGULATION IN HEMODIALYSIS: DIVERGENT PREDICTORS OF HYPOTENSION AND HYPOGLYCEMIA

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Co-author 1

Huda Akrabi drakrabi@gmail.com KCMC Univeristy Internal Medicin Moshi Tanzania *

Co-author 2

Fuad Said fuad_hamoud@hotmail.com KCMC University Internal Medicine Moshi Tanzania -

Co-author 3

Abel Mwanga abelmwanga315@gmail.com Kilimanjaro Christian Medical Centre Internal Medicine Moshi Tanzania -

Co-author 4

Emmanuel Kwanama emmanuelkwanama@gmail.com KCMC University Internal Medicine Moshi Tanzania -

Co-author 5

Kajiru Kilonzo kajiru@yahoo.com KCMC University Internal Medicine Moshi Tanzania -

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Introduction

Autonomic dysregulation is a recognized driver of hemodynamic and metabolic instability in patients receiving hemodialysis (HD). Intradialytic hypotension (IDH) and intradialytic hypoglycemia (IDHG) have both been described to represent parallel manifestations of impaired autonomic control. Building on two KCMC studies, we explored predictors of IDH and IDHG to hypothesize on their autonomic origins.

Methods

Findings were synthesized from two similar datasets from the same hemodialysis unit: (1) A cross-sectional study of 122 adults on maintenance HD assessing capillary glucose pre-HD and hourly during dialysis (IDHG defined as <3.9 mmol/L). (2) A retrospective cohort of 4,706 HD sessions among 39 patients screened for IDH (≥20 mmHg systolic drop with symptoms). Multivariable models identified independent predictors, and overlapping demographic and clinical profiles were qualitatively analyzed to assess autonomic links.

Results

Intradialytic hypoglycemia (IDHG) occurred in 10.7% of patients; 69% of episodes were observed among diabetics. Independent predictors of IDHG included older age, longer diabetes duration, and longer dialysis vintage (all p < 0.05). The incidence of Intradialytic hypotension (IDH) was 4.35% of which 46.3% were recurrent episodes. Independent predictors of recurrent hypotension included male sex (aRR 9.65, p < 0.01), hyperphosphatemia > 1.8 mmol/L (RR 2.33, p < 0.05), and a protective effect of pre-HD SBP < 140 mmHg (aRR 0.34, p < 0.01). Although diabetes was prevalent (58%), it was not an independent predictor of recurrent IDH. Both complications frequently co-occurred in the same individuals, resulting in session interruptions and hospitalizations.

Conclusion

It is very likely that IDH and IDHG do not arise from the same autonomic fault line because the predictors among these similar populations are distinct.. Future prospective studies integrating continuous glucose and hemodynamics monitoring are warranted to clarify causal pathways and guide targeted preventive strategies.

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