Intradialytic blood pressure instability and associated factors among hemodialysis patients in Somalia: a retrospective study.

Background: Intradialytic blood pressure (BP) instability-manifesting as intradialytic hypotension (IDH) or hypertension (IDHT)-is increasingly recognized as a contributor to cardiovascular morbidity in hemodialysis patients. Despite its clinical significance, data on intradialytic BP behavior from sub-Saharan Africa remain scarce. Objective: To determine the prevalence and clinical factors associated with intradialytic BP changes among chronic kidney disease (CKD) patients on maintenance hemodialysis in a tertiary hospital in Somalia. Methods: We conducted a retrospective observational study of adult patients undergoing maintenance hemodialysis at Mogadishu Somali Turkish Training and Research Hospital between June and September 2022. Intradialytic hypotension was defined as a ≥20 mmHg drop in systolic BP and/or ≥10 mmHg drop in mean arterial pressure (MAP), while IDHT was defined as a >10 mmHg increase in systolic BP and/or ≥15 mmHg increase in MAP from pre- to post-dialysis. Demographic, clinical, dialysis, and laboratory variables were extracted. Logistic regression models were used to evaluate factors associated with IDH and IDHT, with reduced modeling for IDHT because of the small number of events. Results: Among 149 patients (mean age 51.1 ± 16.4 years; 57.7% female), the prevalence of IDH and IDHT was 55.0% and 12.1%, respectively. Most patients (74.5%) had hypertension and 96.5% used an arteriovenous fistula. In multivariable analysis, higher pre-dialysis systolic BP (OR 1.037; 95% CI 1.018-1.056) and ultrafiltration goal (OR 1.537; 95% CI 1.002-2.357) were associated with IDH. Because pre-dialysis systolic BP contributed to the outcome definition, this association should be interpreted cautiously. In the reduced IDHT model, ultrafiltration goal was inversely associated with IDHT (OR 0.543; 95% CI 0.298-0.990), while antihypertensive medication burden was not statistically significant. Exploratory electrolyte tertile analysis showed a higher proportion of IDH among patients in lower calcium and higher phosphate tertiles. Conclusion: Intradialytic BP instability was common among hemodialysis patients in Somalia, particularly IDH. Given the retrospective design, reliance on pre- and post-dialysis BP measurements, and limited number of IDHT events, the findings should be interpreted as associative and hypothesis-generating. Routine BP monitoring and further prospective studies are warranted to better characterize hemodynamic instability in resource-constrained dialysis settings.