Kidney Res Clin Pract.  2022 Sep;41(5):611-622. 10.23876/j.krcp.21.153.

The importance of muscle mass in predicting intradialytic hypotension in patients undergoing maintenance hemodialysis

Affiliations
  • 1Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  • 2Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  • 3Choi’s Medical Clinic, Suwon, Republic of Korea
  • 4Gojan Myeong Internal Medicine Clinic, Ansan, Republic of Korea
  • 5Division of Nephrology, Department of Internal Medicine, Ajou University Hospital, Suwon, Republic of Korea
  • 6Department of Internal Medicine, Ajou University School of Medicine, Suwon, Republic of Korea
  • 7Division of Nephrology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
  • 8Division of Nephrology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  • 9Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
  • 10Medical Research Collaborating Center, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
  • 11Department of Public Health Science, School of Public Health, Seoul National University, Seoul, Republic of Korea

Abstract

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.

Keyword

Body composition; Hypotension; Renal dialysis; Sarcopenia
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