Factors affecting hemodynamics during dialysis sessions in pediatric hemodyalisis patients

Objectives: The aim of this study was to evaluate intradialytic hemodynamic changes and the factors affecting these changes in pediatric patients undergoing hemodialysis. Materials and Methods: Fifteen pediatric patients aged 7–17 years who were receiving hemodialysis treatment at Çukurova University Faculty of Medicine were included in the study. Demographic characteristics, etiologies of chronic kidney disease, dialysis adequacy parameters, anthropometric measurements, and biochemical data were recorded. During the intradialytic period, peripheral and central blood pressure, heart rate, pulse pressure, mean arterial pressure (MAP), pulse wave velocity (PWV), and augmentation index (AIx) were measured. In addition, 24-hour ambulatory blood pressure monitoring covering the entire post-dialysis day was performed using the Mobil- O-Graph device. The relationships between ultrafiltration (UF) rates and hemodynamic parameters were analyzed. Vital signs, dialysis prescriptions, and intradialytic complications were recorded throughout the 4-hour dialysis sessions. Results: The mean age of the patients was 13.2 ± 3.3 years, and the most common etiology of chronic kidney disease was steroid-resistant nephrotic syndrome (53.3%). Anthropometric measurements revealed markedly reduced height, weight, and body mass index (BMI) SDS values. At least one intradialytic complication occurred in 30.8% of dialysis sessions, with intradialytic hypotension being the most frequent complication. During dialysis, systolic, diastolic, and central blood pressure values showed a significant decrease, particularly up to the third hour. PWV and AIx values were higher during daytime measurements and showed a significant decline during the nighttime period. Although PWV and AIx demonstrated variability during the intradialytic period, a significant positive correlation was observed only between first-hour PWV measurements and the UF-to-body weight ratio (r = 0.497, p = 0.010). No significant association was found between systolic or diastolic dipper/non-dipper status and left ventricular hypertrophy. Conclusion: This study demonstrates that intradialytic hemodynamic changes in pediatric hemodialysis patients are particularly prominent during the early intradialytic period, with ultrafiltration emerging as a key determinant of these changes. The time- dependent variability of arterial stiffness markers such as PWV and AIx indicates that intradialytic cardiovascular load is a dynamic process. Individualization of ultrafiltration and close monitoring during the early intradialytic period are crucial for maintaining hemodynamic stability. Key Words: Children, hemodialysis, blood pressure, PWV, AIx