The temporal association between percutaneous coronary intervention and intradialytic hypotension in hemodialysis patients

Abstract Background Cardiovascular disease is a leading cause of mortality in end-stage kidney disease, with ischemic heart disease being prevalent. Intradialytic hypotension (IDH) is a common complication during hemodialysis (HD), with poorly understood associations with coronary artery disease and the impact of percutaneous coronary intervention (PCI). This study examines the temporal effects of PCI on IDH in dialysis patients. Methods Patients undergoing HD at National Cheng Kung University Hospital from 1 January 2016 to 30 November 2022 were included. IDH was defined as a systolic blood pressure below 90 mmHg. HD sessions for 180 days before and after PCI were analyzed using generalized estimating equations. We calculated odds ratios (ORs) for IDH risk at various intervals relative to PCI, adjusting for demographics, comorbidities, dialysis parameters, antihypertensive medication use, and laboratory data. Results In total, 39 patients underwent 51 PCI procedures, with 6938 sessions analyzed. Within 90 days post-PCI, IDH risk decreased significantly (OR 0.667; 95% CI 0.465–0.957; P = 0.028) compared with baseline (90 days pre-PCI), but no statistically significant reduction within 91–180 days. Patients with diabetes exhibited a pronounced reduction in IDH risk within 90 days (OR 0.545; 95% CI 0.378–0.786; P = 0.001) and in 180 days (OR 0.551; 95% CI 0.379–0.799; P = 0.002). Monthly trends indicated a gradual increase in IDH risk pre-PCI, peaking 2 months prior to PCI, followed by a sustained decline during the first 3 months post-PCI. Conclusions PCI is associated with a reduction in the risk of IDH, particularly in patients with diabetes, within the first 3 months post-intervention. This study highlights the temporal benefits of PCI in managing IDH, especially in high-risk populations, such as dialysis patients with DM. Further investigation into PCI benefits is warranted.