Hemodialysis prescription education decreases intradialytic hypotension.

Background: Intradialytic hypotension (IDH) is associated with increased morbidity and mortality. We studied the impact of an education program and hemodialysis (HD) prescription optimization on the frequency of IDH.

Methods: We compared chronic HD patients during 2 retrospective time periods: a control period and the study period which occurred after 2 months of physician education and HD prescription optimization. Primary study outcomes were the frequency of HD sessions complicated by IDH, and the prevalence of IDH-prone patients.

Results: There were 91 and 82 patients in the control and study periods, respectively. In the study period, 11% (115/1107) of HD sessions were complicated by IDH vs. 17% (189/1103) in the control period (p = 0.0002). There was a decreased odds ratio for IDH in the study period compared with control (odds ratio [OR] = 0.59; 95% confidence interval [95% CI], 0.40-0.86; p = 0.007). Compared with control, more patients in the study period were prescribed at least 2 preventative strategies (42% vs. 61%, p = 0.02), including increased use of cool dialysate (55% vs. 89%, p<0.001). Cool dialysate reduced the odds of IDH by 50% (OR = 0.50; 95% CI, 0.30-0.86; p = 0.012).

Conclusion: HD prescription education with concurrent use of multiple preventative strategies is associated with a significant decrease in IDH.