How can we prevent intradialytic hypotension?

Research output: Contribution to journalArticle

40 Citations (Scopus)

Abstract

Purpose of Review: Intradialytic hypotension (IDH) produces uncomfortable symptoms for the patient and reduces the efficiency of dialysis. Recent Findings: IDH may be an important cause of vascular access thrombosis. Automatic biofeedback-controlled dialysis changes dialysate conductivity and ultrafiltration during dialysis. A number of trials suggest that automatic feedback-controlled dialysis improves IDH in part by improvement in myocardial stunning and preservation of cardiac function. However, the effects of automatic biofeedback dialysis are inconsistent between studies and sample sizes are small. Acetate even in small amounts may trigger IDH especially in predisposed patients. Cool temperature dialysate causes vasoconstriction, activates the sympathetic nervous system, preserves central blood volume, and mitigates IDH. Increasing the treatment time to at least 4h three times a week and limiting dialysate and dietary sodium intake are effective ways to reduce IDH. Ultrafiltration profiling needs further work, but it appears that removing more fluid during the first hour of dialysis and reducing the rate later on may also reduce IDH. Summary: Adequate prescription and frequency of dialysis treatments, limiting dietary and dialysate sodium, ultrafiltration profiling, automatic biofeedback-controlled dialysis, avoidance of acetate, and cool temperature dialysate may be effective strategies to reduce IDH.

Original languageEnglish (US)
Pages (from-to)593-599
Number of pages7
JournalCurrent Opinion in Nephrology and Hypertension
Volume21
Issue number6
DOIs
StatePublished - Nov 2012

Fingerprint

Hypotension
Dialysis
Dialysis Solutions
Ultrafiltration
Dietary Sodium
Acetates
Myocardial Stunning
Temperature
Sympathetic Nervous System
Vasoconstriction
Blood Volume
Sample Size
Prescriptions
Blood Vessels
Thrombosis
Therapeutics

Keywords

  • dialysis
  • end-stage renal disease
  • hypotension

ASJC Scopus subject areas

  • Nephrology
  • Internal Medicine

Cite this

How can we prevent intradialytic hypotension? / Agarwal, Rajiv.

In: Current Opinion in Nephrology and Hypertension, Vol. 21, No. 6, 11.2012, p. 593-599.

Research output: Contribution to journalArticle

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