{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T02:01:19Z","timestamp":1793671279194,"version":"4.5.1"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["CJASN"],"published-print":{"date-parts":[[2018,10]]},"abstract":"\n Background and objectives<\/jats:title>\n Mesenteric ischemia is a rare but devastating condition caused by insufficient blood supply to meet the demands of intestinal metabolism. In patients with ESKD, it can be difficult to diagnose and has a >70% mortality rate. Patients on hemodialysis have a high prevalence of predisposing conditions for mesenteric ischemia, but the contribution of intradialytic hypotension, a potential modifiable risk factor, has not been well described.<\/jats:p>\n <\/jats:sec>\n \n Design, setting, participants, & measurements<\/jats:title>\n We used data from the US Renal Data System to identify 626 patients on hemodialysis with a hospitalized mesenteric ischemia event (cases). We selected 2428 controls in up to a 1:4 ratio matched by age, sex, black race, incident dialysis year, diabetes mellitus, coronary artery disease, and peripheral artery disease. We used six different definitions of intradialytic hypotension on the basis of prior studies, and categorized patients as having had intradialytic hypotension if \u226530% of hemodialysis sessions in the 30 days before the event met the specified definition.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The proportion of patients with intradialytic hypotension varied depending on its definition: from 19% to 92% of cases and 11% to 94% of controls. Cases had a higher adjusted odds (1.82; 95% confidence interval, 1.47 to 2.26) of having had intradialytic hypotension in the preceding 30 days than controls when using nadir-based intradialytic hypotension definitions such as nadir systolic BP <90 mm Hg. To examine a potential dose-response association of intradialytic hypotension with hospitalized mesenteric ischemia, we categorized patients by the proportion of hemodialysis sessions having intradialytic hypotension, defined using the Nadir90 definition (0%, 1%\u20139%, 10%\u201329%, 30%\u201349%, and \u226550%), and found a direct association of proportion of intradialytic hypotension with hospitalized mesenteric ischemia (\n P<\/jats:italic>\n -trend<0.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Patients with hospitalized mesenteric ischemia had significantly higher odds of having had intradialytic hypotension in the preceding 30 days than controls, as defined by nadir-based definitions.<\/jats:p>\n <\/jats:sec>","DOI":"10.2215\/cjn.13891217","type":"journal-article","created":{"date-parts":[[2018,9,20]],"date-time":"2018-09-20T12:24:33Z","timestamp":1537446273000},"page":"1517-1525","source":"Crossref","is-referenced-by-count":53,"title":["The Relationship between Intradialytic Hypotension and Hospitalized Mesenteric Ischemia"],"prefix":"10.2215","volume":"13","author":[{"given":"Eun Young","family":"Seong","sequence":"first","affiliation":[{"name":"Division of Nephrology, Stanford University School of Medicine, Palo Alto, California;"},{"name":"Division of Nephrology, Pusan National University School of Medicine, Pusan, South Korea; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanchao","family":"Zheng","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Stanford University School of Medicine, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5272-425X","authenticated-orcid":false,"given":"Wolfgang C.","family":"Winkelmayer","sequence":"additional","affiliation":[{"name":"Section of Nephrology, Baylor College of Medicine, Houston, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria E.","family":"Montez-Rath","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Stanford University School of Medicine, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tara I.","family":"Chang","sequence":"additional","affiliation":[{"name":"Division of Nephrology, Stanford University School of Medicine, Palo Alto, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2018,9,20]]},"reference":[{"key":"B1-20230813","doi-asserted-by":"crossref","first-page":"959","DOI":"10.1056\/NEJMra1503884","article-title":"Mesenteric ischemia.","volume":"374","author":"Clair","year":"2016","journal-title":"N Engl J Med"},{"key":"B2-20230813","doi-asserted-by":"crossref","first-page":"491","DOI":"10.1159\/000338451","article-title":"Mesenteric ischemia in patients with end-stage renal disease: A nationwide longitudinal study.","volume":"35","author":"Li","year":"2012","journal-title":"Am J Nephrol"},{"key":"B3-20230813","doi-asserted-by":"crossref","first-page":"911","DOI":"10.1093\/ndt\/gfg004","article-title":"Mesenteric ischaemia in haemodialysis patients: A case\/control study.","volume":"18","author":"Bassilios","year":"2003","journal-title":"Nephrol Dial Transplant"},{"key":"B4-20230813","doi-asserted-by":"crossref","first-page":"494","DOI":"10.1016\/S0039-6060(05)80247-8","article-title":"Acute abdomen in the hemodialysis patient population.","volume":"117","author":"Bender","year":"1995","journal-title":"Surgery"},{"key":"B5-20230813","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1002\/bjs.4459","article-title":"Systematic review of survival after acute mesenteric ischaemia according to disease aetiology.","volume":"91","author":"Schoots","year":"2004","journal-title":"Br J Surg"},{"key":"B6-20230813","first-page":"81","article-title":"Nonocclusive mesenteric ischemia in a patient on maintenance hemodialysis.","volume":"15","author":"Han","year":"2000","journal-title":"Korean J Intern Med (Korean Assoc Intern Med)"},{"key":"B7-20230813","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1016\/S0039-6109(05)70551-X","article-title":"Nonocclusive mesenteric ischemia.","volume":"77","author":"Bassiouny","year":"1997","journal-title":"Surg Clin North Am"},{"key":"B8-20230813","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1016\/S1072-7515(99)00226-4","article-title":"Nonocclusive mesenteric infarction in hemodialysis patients.","volume":"190","author":"John","year":"2000","journal-title":"J Am Coll Surg"},{"key":"B9-20230813","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1111\/hdi.12138","article-title":"Intradialytic hypotension: Frequency, sources of variation and correlation with clinical outcome.","volume":"18","author":"Sands","year":"2014","journal-title":"Hemodial Int"},{"key":"B10-20230813","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1016\/S0140-6736(16)30508-6","article-title":"The heart and vascular system in dialysis.","volume":"388","author":"Wanner","year":"2016","journal-title":"Lancet"},{"key":"B11-20230813","doi-asserted-by":"crossref","first-page":"914","DOI":"10.2215\/CJN.03900808","article-title":"Hemodialysis-induced cardiac injury: Determinants and associated outcomes.","volume":"4","author":"Burton","year":"2009","journal-title":"Clin J Am Soc Nephrol"},{"key":"B12-20230813","doi-asserted-by":"crossref","first-page":"2511","DOI":"10.1681\/ASN.2016060704","article-title":"Relationship between hypotension and cerebral ischemia during hemodialysis.","volume":"28","author":"MacEwen","year":"2017","journal-title":"J Am Soc Nephrol"},{"key":"B13-20230813","doi-asserted-by":"crossref","first-page":"1393","DOI":"10.1097\/00003246-200107000-00015","article-title":"Splanchnic perfusion during hemodialysis: Evidence for marginal tissue perfusion.","volume":"29","author":"Jakob","year":"2001","journal-title":"Crit Care Med"},{"key":"B14-20230813","doi-asserted-by":"crossref","first-page":"1526","DOI":"10.1681\/ASN.2010101119","article-title":"Intradialytic hypotension and vascular access thrombosis.","volume":"22","author":"Chang","year":"2011","journal-title":"J Am Soc Nephrol"},{"key":"B15-20230813","doi-asserted-by":"crossref","first-page":"724","DOI":"10.1681\/ASN.2014020222","article-title":"Association of mortality risk with various definitions of intradialytic hypotension.","volume":"26","author":"Flythe","year":"2015","journal-title":"J Am Soc Nephrol"},{"key":"B16-20230813","doi-asserted-by":"crossref","first-page":"2124","DOI":"10.2215\/CJN.02680314","article-title":"Intradialytic hypotension and risk of cardiovascular disease.","volume":"9","author":"Stef\u00e1nsson","year":"2014","journal-title":"Clin J Am Soc Nephrol"},{"key":"B17-20230813","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1016\/S0272-6386(12)80533-6","article-title":"Nonocclusive mesenteric ischemia in renal patients: Recognition and prevention of intestinal gangrene.","volume":"15","author":"Valentine","year":"1990","journal-title":"Am J Kidney Dis"},{"key":"B18-20230813","doi-asserted-by":"crossref","first-page":"c87","DOI":"10.1159\/000086346","article-title":"Non-occlusive mesenteric ischemia in chronically dialyzed patients: A disease with multiple risk factors.","volume":"101","author":"Ori","year":"2005","journal-title":"Nephron Clin Pract"},{"key":"B19-20230813","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.jss.2012.10.008","article-title":"Detection of patients at high risk for non-occlusive mesenteric ischemia in hemodialysis.","volume":"180","author":"Quiroga","year":"2013","journal-title":"J Surg Res"},{"key":"B20-20230813","doi-asserted-by":"crossref","first-page":"e1482","DOI":"10.1097\/MD.0000000000001482","article-title":"Different risk of common gastrointestinal disease between groups undergoing hemodialysis or peritoneal dialysis or with non-end stage renal disease: A nationwide population-based cohort study.","volume":"94","author":"Lee","year":"2015","journal-title":"Medicine (Baltimore)"},{"key":"B21-20230813","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1002\/pds.1118","article-title":"Algorithms to identify colonic ischemia, complications of constipation and irritable bowel syndrome in medical claims data: Development and validation.","volume":"15","author":"Sands","year":"2006","journal-title":"Pharmacoepidemiol Drug Saf"},{"key":"B22-20230813","doi-asserted-by":"crossref","first-page":"2042","DOI":"10.1681\/ASN.2012060554","article-title":"Multivessel coronary artery bypass grafting versus percutaneous coronary intervention in ESRD.","volume":"23","author":"Chang","year":"2012","journal-title":"J Am Soc Nephrol"},{"key":"B23-20230813","doi-asserted-by":"crossref","first-page":"133","DOI":"10.2215\/CJN.04610510","article-title":"Circulating endotoxemia: A novel factor in systemic inflammation and cardiovascular disease in chronic kidney disease.","volume":"6","author":"McIntyre","year":"2011","journal-title":"Clin J Am Soc Nephrol"},{"key":"B24-20230813","doi-asserted-by":"crossref","first-page":"141","DOI":"10.1159\/000366519","article-title":"Circulating endotoxaemia and frequent haemodialysis schedules.","volume":"128","author":"Jefferies","year":"2014","journal-title":"Nephron Clin Pract"},{"key":"B25-20230813","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1177\/089686080702700206","article-title":"Nonocclusive mesenteric ischemia: A lethal complication in peritoneal dialysis patients.","volume":"27","author":"Archodovassilis","year":"2007","journal-title":"Perit Dial Int"},{"issue":"Suppl 3","key":"B26-20230813","first-page":"S1","article-title":"K\/DOQI clinical practice guidelines for cardiovascular disease in dialysis patients.","volume":"45","author":"Workgroup","year":"2005","journal-title":"Am J Kidney Dis"},{"key":"B27-20230813","doi-asserted-by":"crossref","first-page":"149","DOI":"10.1093\/ndt\/gfx037","article-title":"Intradialytic hypotension, blood pressure changes and mortality risk in incident hemodialysis patients.","volume":"33","author":"Chou","year":"2018","journal-title":"Nephrol Dial Transplant"}],"container-title":["Clinical Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/01277230-201810000-00012","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,10]],"date-time":"2026-08-10T13:38:38Z","timestamp":1786369118000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/01277230-201810000-00012"}},"subtitle":["A Case-Control Study"],"short-title":[],"issued":{"date-parts":[[2018,9,20]]},"references-count":27,"journal-issue":{"issue":"10","published-print":{"date-parts":[[2018]]}},"URL":"https:\/\/doi.org\/10.2215\/cjn.13891217","relation":{},"ISSN":["1555-9041","1555-905X"],"issn-type":[{"value":"1555-9041","type":"print"},{"value":"1555-905X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,20]]}}}