<b>Intra-</b><b>D</b><b>ialytic </b><b>H</b><b>ypotension: A </b><b>C</b><b>umbersome </b><b>R</b><b>estorable </b><b>I</b><b&g

Background: Chronic kidney disease (CKD) is a major global health challenge. This study was done to identify the clinical, hemodialysis-related, and laboratory factors associated with intra-dialytic hypotension (IDH) in patients undergoing maintenance hemodialysis. Methods: This prospective observational case–control study was conducted at the Kidney Center, Karachi, from September 2024 to February 2025. Sixty patients on maintenance hemodialysis (>3 months) were enrolled, including 30 with IDH, and 30 without IDH. Non-probability consecutive sampling technique was adopted. Demographics, comorbidities, hemodialysis prescription, interdialytic weight gain, dialysate parameters, medication history, water and food intake, urine output, and laboratory values were recorded. Blood pressure was measured pre-, intra-, and post-dialysis. Data were analyzed using SPSS v26 with appropriate parametric and non-parametric tests taking p<0.05 as significant. Results: In a total of 60 patients, the mean age was 50.9±14.1 years, and 32 (53.3%) patients females. Hypertension was present in 58 (96.7%), and diabetes mellitus in 22 (36.7%) patients. Patients with IDH had longer dialysis vintage (5.5±4.5 vs 3.3±3.9 years, p=0.010). Interdialytic weight gain (2.3±0.8 vs 1.8±0.7 kg, p=0.007) and daily water intake (1.1±0.5 vs 0.8±0.4 L, p=0.023) were higher in IDH. Intradialytic systolic and diastolic BP were significantly lower (88.0±5.8/53.1±6.3 vs 138.4±20.6/82.6±12.8 mmHg, both p<0.001). Serum sodium was reduced in IDH (133.6±4.6 vs 135.9±5.3 mEq/L, p=0.041). Conclusion: Patients with IDH undergoing maintenance hemodialysis were characterized by longer dialysis duration, greater interdialytic weight gain, higher daily fluid intake, lower pre-dialysis diastolic pressure, significantly reduced intradialytic blood pressure values, and lower serum sodium levels compared with those without IDH. Keywords: Blood p