The Association Between Tobacco Use and Intradialytic Hemodynamics in Hemodialysis Patients




Sonderman, Mark

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BACKGROUND: Intradialytic hypotension is known to be associated with increased mortality in maintenance hemodialysis patients. Smoking is a modifiable risk factor that is more commonly seen in patients with large decreases in intradialytic blood pressure as compared to any other intradialytic blood pressure pattern. However, the mechanisms of this association are unknown. We sought to explore the effect of lifetime tobacco use on vascular hemodynamics during dialysis. METHODS: We used impedance cardiography to measure total peripheral resistance index (TPRI) in 65 hypertensive hemodialysis patients. Additionally, we obtained blood pressure measurements before, during, and after midweek hemodialysis treatments. We then compared intradialytic hemodynamic changes between never smokers (n=35) and current or former smokers (n=30) using simple and multivariable linear regression. RESULTS: The mean change in TPRI during a single dialysis session was -438 dynes/sec/cm2/m2 in smokers and -105 dynes/sec/cm2/m2 in non-smokers (p=0.1). The intradialytic systolic blood pressure nadir was 115 mmHg in smokers and 123 mmHg in non-smokers (p=0.1). In multivariable linear regression controlling for diabetes, ultrafiltration rate, and other factors associated with intradialytic blood pressure changes, smoking was independently associated with lower nadir SBP (p=0.01) with a trend to also have a greater decrease in TPRI (p=0.08). CONCLUSIONS: Hemodialysis patients with a smoking history demonstrate a tendency towards a greater reduction in intradialytic TPRI as compared to non-smokers, with a significant independent association for lower nadir SBP. Smoking status should be aggressively ascertained in dialysis patients with significant intradialytic hypotension, but further studies are required to determine the effect of smoking cessation on intradialytic hemodynamics.

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The 56th Annual Medical Student Research Forum at UT Southwestern Medical Center (Tuesday, January 23, 2018, 2-5 p.m., D1.600)
Each year the Medical Student Research Program awards students for the best oral presentation and the best poster presentation as judged by faculty across campus. This author received an award as one of the best poster presentations at this forum.

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Sonderman, M., & Van Buren, P. N. (2018, January 23). The association between tobacco use and intradialytic hemodynamics in hemodialysis patients. Poster session presented at the 56th Annual Medical Student Research Forum, Dallas, TX. Retrieved from

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