Risk factors for post-induction hypotension in patients with end-stage renal disease undergoing general anesthesia

BACKGROUND: Patients with end-stage renal disease (ESRD) are at highly susceptible to hemodynamic instability during anesthesia induction. However, data specific to this population remain limited. METHODS: This retrospective cohort study included 635 adult patients with ESRD who underwent non-cardiac surgery under general anesthesia between 2012 and 2022. Post-induction hypotension was defined as a ≥ 30% reduction in mean arterial pressure (MAP) from baseline within 20 minutes after induction, requiring vasopressor support. Multivariable logistic regression was performed to identify independent predictors. RESULTS: The incidence of post-induction hypotension was 44.1% (95% confidence interval (CI), 40.2-47.9). Independent predictors included age > 65 years, chronic oral antidiabetic therapy, higher propofol dose, rapid sequence induction, and emergency surgery. The incidence of hypotension peaked at 20 min after induction. Dialysis-related variables were not significantly associated with hypotension. CONCLUSION: Post-induction hypotension is common in patients with ESRD and associated with advanced age, chronic antidiabetic therapy, higher propofol dose, rapid sequence induction, and emergency surgery.