Unplanned medical interventions in hemodialysis: a real-world study of hypertonic glucose bolus for intradialytic hypotension

Intradialytic hypotension (IDH) is a common complication during hemodialysis, often managed with hypertonic glucose bolus. However, single-center real-world data on its clinical characteristics and impact on dialysis adequacy are limited. This single-center, retrospective real-world study included 450 prevalent hemodialysis patients followed for one year (2025). Unplanned medical interventions were extracted from the billing system. Clinical characteristics of hypertonic glucose bolus for IDH were analyzed, including dose, timing, hemodynamic response, and glycemic response. Dialysis outcomes (Kt/V, ultrafiltration achievement, treatment time) were compared between sessions with and without glucose bolus for IDH. Factors associated with IDH frequency were identified by multivariate linear regression. A total of 4,268 unplanned interventions were recorded, with glucose bolus for IDH being the most frequent (2,734 events, 64.1%) but accounting for only 1.9% of the total costs of all unplanned interventions. Glucose bolus rapidly increased systolic blood pressure (15.2 ± 5.8 mmHg) within 5 min, with effects lasting 65.8 ± 22.5 min. Diabetic patients showed greater pressure response and longer duration compared to non-diabetics. Sessions with glucose bolus achieved significantly higher Kt/V (1.44 ± 0.20 vs. 1.28 ± 0.24, P < 0.001), ultrafiltration completion rate (94.8% vs. 80.2%, P < 0.001), and lower premature termination rate (5.7% vs. 19.9%, P < 0.001) compared to sessions without glucose bolus. Kt/V > 2.0 was independently associated with increased IDH frequency (β = 7.18, P < 0.001). Hypertonic glucose bolus is a frequent, low-cost intervention that was associated with restoration of blood pressure and allowed patients to complete dialysis, thereby achieving adequate Kt/V. However, excessively high Kt/V may predispose patients to recurrent IDH, warranting careful prescription adjustment.