الفهرس 
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Abstract
Intradialytic hypotension (IDH) is a serious and one of the most frequent complication of haemodialysis. Patients with Intradialytic hypotension show increased morbidity and mortality. The etiology of Intradialytic hypotension is multifactorial and depends on patient-related factors, as well as on complications related to the dialysis procedure.
Diabetes mellitus is the leading cause of chronic kidney disease (CKD) and ESRD worldwide. Approximately 40% of patients with diabetes develop diabetic kidney disease (DKD) resulting in albuminuria, reduction of estimated glomerular filtration rate (eGFR), or both.
The aim of this study is to evaluate the relation between diabetes and occurrence of intradialytic hypotension (IDH) and the association between intradialytic hypotension (IDH) and dialytic age (DA) in patients on chronic hemodialysis.
A cross-sectional study was carried out on hemodialyzed end stage kidney disease patients (94 patients) of all the hemodialysis unit in Assiut health insurance hospital in the period from July 2021 to December 2021. All patients were received 3 hemodialysis sessions per week. The blood flow was from 200 to 300 mL/min. All patients were treated with high-permeability membranes. We excluded patients with advanced heart failure according to the criteria of the European Society of Cardiology and Clinically unstable patients whom were requiring hospital admission. So, our study included 90 patients after exclusion of 4 patient due to advanced heart failure or need hospital admission.
All patient, prior to the dialysis session full history was taking, Blood pressure (BP) was measured with mercury sphygmomanometer before, after and every 60 min during the hemodialysis session (a total of 5 measurements), for 10 consecutive dialysis sessions.
Intradialytic hypotension (IDH) was defined as a decrease in systolic BP by ≥20 mm Hg or a decrease in mean arterial pressure of 10 mm Hg associated with symptoms.
Autonomic neuropathy (AN) was evaluated in all patients by 2 cardiovascular tests blood pressure response to standing and heart rate response to deep breathing test.
Blood samples was obtained for: serum urea, creatinine, Na, K, Ca, P, CBC, serum protein, albumin, liver function tests, Prothrombin time, Prothrombin concentration, INR, glycosylated hemoglobin, fasting blood glucose.
On our study, only 25 patients (27.8 %) had IDH while the other 65 patients (72.2 %) did not suffer from IDH.
It was found that patients suffered from IDH had longer duration of dialysis in comparison to those patients without IDH (6.84 ± 1.17 vs. 3.75 ± 1.13 (years)) while age of patients did not affect occurrence of IDH.
IDH affected females 76 % of IDH group more than males.
Residence of patients did not affect occurrence of IDH where majority of them came from rural areas.
The difference in body mass index (BMI) did not affect occurrence of IDH as regard mean body mass index (24.80 ± 2.14 (IDH group) vs. 23.91 ± 2.78 (non IDH group) (kg/m2).
It was found that both groups of patients based on development of IDH had insignificant differences as regard pre-dialytic systolic blood pressure (117.48 ± 8.50 vs. 120.20 ± 7.36 (mmHg)), diastolic blood pressure (85.04 ± 10.43 vs. 83.43 ± 9.95 (mmHg)), heart rate (76.92 ± 3.21 vs. 78.40 ± 5.41 (beat/minute)) and respiratory rate (23.11 ± 2.06 vs. 23.76 ± 2.82 (c/minute)).
laboratory data showed no significant differences between the studied groups either with IDH or without IDH with except of significantly lower serum albumin (3.5 ± 0.15 vs. 4.21 ± 0.12 (g/dl)) and significantly higher glycosylated haemoglobin (8.09 ± 2.22 vs. 5.45 ± 1.90 (%)) among patients with IDH.
Patients suffering from autonomic neuropathy were more liable to IDH based on heart rate response to deep breathing test (76% vs. 27.75%) and based on blood pressure response to standing (68% vs. 23.1%) in comparison to those without IDH.