Low blood pressure during hemodialysis may indicate peripheral vascular disease

Using a large nationwide registry of patients receiving maintenance hemodialysis, this study published in the American Journal of Kidney Diseases found that higher frequency of low blood pressure episodes during hemodialysis was associated with a higher incidence of diagnosed peripheral arterial disease.

Peripheral artery disease (PAD) is a condition characterized by progressive atherosclerotic narrowing or occlusion of the arteries, particularly to the lower extremities. PAD often goes undiagnosed in patients with kidney failure who may not experience traditional symptoms of claudication. It is plausible that sudden reductions in blood pressure as occurs during intradialytic hypotension (IDH) could reduce limb perfusion and lead to more PAD events or exacerbate PAD symptoms. Using a large nationwide registry of hemodialysis patients and the electronic health records of a large dialysis provider, researchers found that more frequent IDH was associated with a higher incidence of recognized PAD.

These results suggest that patients with more frequent IDH warrant careful examination for PAD such as foot examinations or other diagnostic evaluations.