Risk Factors for Intradialytic Hypotension in Chronic Kidney Disease Patients Undergoing Hemodialysis

Faizah Ramadhani; Fitri Mailani; Devia Putri Lenggogeni

doi:10.25077/njk.v21i2.357

Authors

Faizah Ramadhani Bachelor study Faculty of Nursing Universitas Andalas, Padang, West Sumatra, Indonesia
Fitri Mailani Department Medical Surgical and Emergency Nursing, Faculty of Nursing, Universitas Andalas, West Sumatra, Indonesia
Devia Putri Lenggogeni Department Medical Surgical and Emergency Nursing, Faculty of Nursing, Universitas Andalas, West Sumatra, Indonesia

DOI:

https://doi.org/10.25077/njk.v21i2.357

Keywords:

Chronic kidney disease, Complication, Hemodialysis, IDWG

Abstract

Intradialytic hypotension (IDH) is one of the most common complications of hemodialysis therapy experienced by hemodialysis patients, with a prevalence of 8–40%. IDH carries important clinical consequences, including reduced dialysis adequacy and interruption of treatment sessions. Several factors are known increase the occurrence of IDH. This study aimed to identify risk factors influencing the occurrence of intradialytic hypotension in patients with chronic kidney disease undergoing hemodialysis. This study used a quantitative method with a cross-sectional design. The study was conducted in the hemodialysis unit of a government hospital in Padang City. The sampling technique was purposive sampling with a sample size of 104 respondents with inclusion and exclusion criteria, between April and May 2025. Data analysis used the Chi-Square test and the Mann-Whitney U test. The results showed that gender, dialysate temperature, and meals during hemodialysis were not associated with intradialytic hypotension (p > 0.05). However, hemoglobin and Interdialytic Weight Gain (IDWG) were related to the occurrence of intradialytic hypotension (p < 0.05). Based on the results of this study, nurses can monitor and evaluate anemia status and IDWG, which can influence the incidence of intradialytic hypotension. The role of nurses in improving dietary compliance and fluid restriction is crucial in preventing intradialytic hypotension.

References

Agarwal, R., & Georgianos, P. (2018). Feeding during dialysis - Risks and uncertainties. Nephrology Dialysis Transplantation, 33(6), 917–922. https://doi.org/10.1093/ndt/gfx195.

Ali, M., Ejaz, A., Iram, H., Solangi, S. A., Junejo, A. M., & Solangi, S. A. (2021). Frequency of Intradialytic Complications in Patients of End-Stage Renal Disease on Maintenance Hemodialysis. Cureus. https://doi.org/10.7759/cureus.12641

Benaroia, M., & Iliescu, E. A. (2008). Oral intake during hemodialysis: Is there an association with intradialytic hypotension? Hemodialysis International, 12, 62–65.

Desy Wahidi, K., Nursanti, I., Irawati, D., Jumaiyah, W., & Yuniarsih, W. (2022). Pengaruh Pengaturan Suhu Dialisat Terahadap Stabilitas Tekanan Darah Intradialitik Pasien Hemodialisis Dengan Sindrom Kardiorenal. Jurnal Perawat Indonesia, 6(2), 1096–1108. https://doi.org/https://doi.org/10.32584/jpi.v6i2.1762.

Gamboa, J. L., Mambungu, C. A., Clagett, A. R., Nian, H., Yu, C., Ikizler, T. A., & Brown, N. J. (2023). Bradykinin B2 receptor blockade and intradialytic hypotension. BMC Nephrology, 24(134). https://doi.org/10.1186/s12882-023-03192-4

Gehman, K. S. (2023). Global Kidney Health Atlas 2023. www.theisn.org/global-atlas

Goyal, S., Bhat, A., & Kumar, S. (2024). The Effect of Intradialytic Food Intake on Hemodialysis Adequacy and Blood Pressure; a quasi-experimental study. Journal of Nephropathology, 13(3). https://doi.org/10.34172/jnp.2023.21460.

Halle, M. P., Djantio, H., Francois, K. F., Denis, T., Fouda, H., & Gloria, A. (2020). Intradialytic Hypotension and Associated Factors among Patients on Maintenance Hemodialysis: A Single-Center Study in Cameroon. Journal of Kidney Diseases and Transplantation, Vol 31, No 1, 215–223. https://doi.org/10.4103/1319-2442.279944.

Hara, T., Kasahara, Y., & Nakagawa, T. (2022). Association between haemoglobin concentration and intradialytic hypotension in patients undergoing maintenance haemodialysis: A retrospective cohort study. BMJ Open, 12(8). https://doi.org/10.1136/bmjopen-2022-064026.

Indonesia Renal Registry. (2023). 13th Annual Report of Indonesian Renal Registry 2020. www.indonesianrenalregistry.org.

Juliardi, F., Dewi, J., Aryandra Hasibuan, M., & Tiarnida. (2020). PENINGKATAN IDWG BERHUBUNGAN DENGAN KEJADIAN HIPOTENSI PADA PASIEN HEMODIALISIS. Jurnal Penelitian Perawat Profesional, 2(3). https://jurnal.globalhealthsciencegroup.com/index.php/JPPP.

Kanbay, M., Ertuglu, L. A., Afsar, B., Ozdogan, E., Siriopol, D., Covic, A., Basile, C., & Ortiz, A. (2020). An update review of intradialytic hypotension: Concept, risk factors, clinical implications and management. In Clinical Kidney Journal (Vol. 13, Issue 6, pp. 981–993). Oxford University Press. https://doi.org/10.1093/CKJ/SFAA078.

Kistler, B. M., Benner, D., Burrowes, J. D., Campbell, K. L., Fouque, D., Garibotto, G., Kopple, J. D., Kovesdy, C. P., Rhee, C. M., Steiber, A., Stenvinkel, P., ter Wee, P., Teta, D., Wang, A. Y. M., & Kalantar-Zadeh, K. (2018). Eating During Hemodialysis Treatment: A Consensus Statement From the International Society of Renal Nutrition and Metabolism. In Journal of Renal Nutrition (Vol. 28, Issue 1, pp. 4–12). W.B. Saunders. https://doi.org/10.1053/j.jrn.2017.10.003.

Kuipers, J., Oosterhuis, J. K., Krijnen, W. P., Dasselaar, J. J., Gaillard, C. A. J. M., Westerhuis, R., & Franssen, C. F. M. (2016). Prevalence of intradialytic hypotension, clinical symptoms and nursing interventions - A three-month, prospective study of 3818 haemodialysis sessions. Dialysis and Transplantation. BMC Nephrology, 17(1). https://doi.org/10.1186/s12882-016-0231-9

Mailani, F., Mansur, A. R., Rifdatunnisa, A., & Chan, C. M. (2025). Factors Related to Fatigue among Chronic Kidney Disease Patients on Hemodialysis. Nurse Media Journal of Nursing, 15(1). https://doi.org/10.14710/nmjn.v15i1.59980.

Mustafa, R. A., Bdair. F, & Akl, E. A. (2016). Effect of Lowering the Dialysate Temperature in Chronic Hemodialysis: A Systematic Review and Meta-Analysis. Clinical Journal of American Society of Nephrology, 11(3), 442–457.

Pangkey, B. C. A., Klaping, A. A., Lote, A. C. K., Wariso, P. A., & Silaban, W. (2024). Faktor- Faktor yang Berhubungan dengan Perubahan Tekanan Darah pada Pasien Hemodialisis. Jurnal ’Aisyiyah Medika, 9(2), 450–465. https://jurnal.stikes-aisyiyah-palembang.ac.id/index.php/JAM/article/download/1254/976.

Prasetyo, A., Pranowo, S., & Handayani, N. (2018). Karakteristik Pasien gagal ginjal yang menjalani Terapi Hemodialisa di RSUD Cilacap. Prosiding Seminar Nasional Dan Diseminasi Kesehatan STIKes Bakti Tunas Husada Tasikmalaya, 1–6.

Price, I. N., & Wood, A. F. (2022). Chronic Kidney Disease and Renal Replacement Therapy-An Overview for the Advanced Clinical Practitioner. British Journal of Nursing, 31(3), 124–134. https://doi.org/10.12968/bjon.2022.31.3.124.

Raja, S. M., & Seyoum, Y. (2020). Intradialytic complications among patients on twice-weekly maintenance hemodialysis: An experience from a hemodialysis center in Eritrea. BMC Nephrology, 21(1). https://doi.org/10.1186/s12882-020-01806-9.

Sijabat, R. A., & Yenny. (2020). Gambaran kejadian hipotensi intradialisis pada pasien yang menjalani hemodialisis di RS PGI Cikini. Jurnal Keperawatan Cikini, 1(1), 11–15.

Riskesdas. (2019). Laporan Riskesdas 2018 Nasional. Lembaga Penerbit Badan Penelitian dan Pengembangan Kesehatan.

Sarbaz, H., Kiyani, F., Keikhaei, A., & Bouya, S. (2019). The Effect of Reduced Dialysate Temperature on Dialysis Adequacy of Diabetic Patients Admitted to Ali-Ibn Abitaleb Hospital, Zahedan: A Clinical Trial. Medical - Surgical Nursing Journal, In Press(In Press). https://doi.org/10.5812/msnj.90518.

Septimar, Z. M., & Nurmalahayati, D. R. (2019). Faktor- Faktor yang Mempengaruhi Hipotensi Intradialisis pada Pasien Gagal Ginjal Kronik yang Menjalani Hemodialisis. Jurnal Ilmu Kesehatan Masyarakat, 8(1), 1–5.

Sidiq, M. N. (2021). Faktor-faktor yang Menyebabkan Hipotensi Intradialisis : Literature Review. Jurnal Berita Ilmu Keperawatan, 14(1). https://doi.org/10.23917/BIK.V14I1.11601.

Siregar, C. T. (2020). Buku Ajar Manajemen Komplikasi Pasien Hemodialisa. (R. A. Ariga, Ed.; 1st ed.). Deepublish.

Tampah, N., Masi, G., & Nurmansyah, M. (2023). Faktor- Faktor yang Mempengaruhi Terjadinya Hipotensi Intradialisis pada PasienGagal Ginjal Kronik Di ruangan Hemodialisis Melatirsup Prof dr. R. D. Kandou Manado. Jurnal Keperawatan, 11(1), 56–63.

Wang, J., Yao, J., Zhu, X., Wang, T., Lu, J., Wei, Q., Xue, J., Wu, Y., & You, L. (2023). Impact of frequent intradialytic hypotension on quality of life in patients undergoing hemodialysis. BMC Nephrology, 24(209), 1–10. https://doi.org/10.1186/s12882-023-03263-6.

Wibowo, H. P., & Siregar, W. D. (2020). Hubungan Inteedialytic Weight Gains (IDWG) dengan terjadinya komplikasi durante hemodialisis pada pasien ginjal kronik. Jurnal Keperawatan Priority, 3(1), 13–22. https://doi.org/https:/doi.org/10.34012/jukep.v3i1.806.