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KMID : 1102220220410050611
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Kidney Research and Clinical Practice
2022 Volume.41 No. 5 p.611 ~ p.622
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The importance of muscle mass in predicting intradialytic hypotension in patients undergoing maintenance hemodialysis
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Son Hyung-Eun
Ryu Ji-Young
Lee Kyung-Hoon
Choi Young-Il
Kim Myeong-Sung
Park In-Whee
Shin Gyu-Tae
Kim Heung-Soo
Ahn Curie
Kim Se-Joong
Chin Ho-Jun
Na Ki-Young
Chae Dong-Wan
Ahn So-Yeon
Hwang Seung-Sik
Jeong Jong-Cheol
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Abstract
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Background: Patients undergoing hemodialysis are susceptible to sarcopenia. As intracellular reservoirs of water, skeletal muscles are important contributors to intradialytic hypotension. This study was designed to determine the role of skeletal muscle mass in intradialytic hypotension.
Methods: In a cross-sectional study, the body composition of 177 patients was measured immediately after hemodialysis using bioelectrical impedance analysis. The parameters measured were skeletal muscle mass, intracellular and extracellular water contents, total body water, and cell-membrane functionality (in phase angle at 50 kHz). Data from laboratory tests, chest radiography, measurements of handgrip strength and mid-arm circumference, and questionnaires were collected. The main outcome was intradialytic hypotension, defined as more than two episodes of hypotension (systolic blood pressure of <90 mmHg) with intervention over the 3 months following enrollment. Logistic regression models including each parameter related to sarcopenia were compared with a clinical model.
Results: Patients with a low ratio of skeletal muscle mass to dry body weight (SMM/WT) had a higher rate of intradialytic hypotension (40.7%). Most low-SMM/WT patients were female, obese, diabetic, and had a lower handgrip strength compared with the other patients. In the high-SMM/WT group, the risk of intradialytic hypotension was lower, with an odds ratio of 0.08 (95% confidence interval [CI], 0.02-0.28) and adjusted odds ratio of 0.06 (95% CI, 0.01-0.29).
Conclusion: Measurement and maintenance of skeletal muscle can help prevent intradialytic hypotension in frail patients undergoing hemodialysis.
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KEYWORD
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Body composition, Hypotension, Renal dialysis, Sarcopenia
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