<![CDATA[Background: Interdialytic weight gain (IDWG) is hypothesized to drive intradialytic blood pressure instability in hemodialysis patients, yet evidence remains contradictory, particularly in low-income and middle-income countries (LMICs) bearing the highest end-stage renal disease (ESRD) burden. We evaluated the association between IDWG and intradialytic blood pressure changes in an Indonesian cohort. Methods: In this cross-sectional study at Lavalette Hospital, Indonesia (May 2025), we enrolled 83 ESRD patients undergoing maintenance hemodialysis. IDWG was calculated as the percentage weight gain between consecutive sessions. Intradialytic blood pressure change was defined as the difference in systolic blood pressure pre- and post-dialysis. Associations were analyzed using Pearson correlation and stratified analyses. Results: The mean age was 52·4 years (SD 12·3), with 43 (52%) women. Most participants (62 [75%]) achieved mild IDWG (<4%), while 37 (45%) maintained stable intradialytic blood pressure, 31 (37%) experienced hypertension, and 15 (18%) hypotension. Despite progressive increases in ultrafiltration rates across IDWG categories (245 to 578 mL/h; p<0·0001), mean blood pressure changes did not differ significantly (p=0·89). Crucially, Pearson analysis revealed no significant linear association between IDWG and intradialytic blood pressure changes (r=–0·209; p=0·057), with IDWG explaining only 4·4% of hemodynamic variance. Conclusion: IDWG alone is an insufficient predictor of intradialytic hemodynamic instability. These findings challenge weight-centric monitoring paradigms, advocating for multifactorial management incorporating ultrafiltration optimization and dialysate profiling. This underscores the urgent need for context-specific, comprehensive hemodialysis quality indicators to advance Sustainable Development Goal targets in resource-constrained settings.]]>
