Intradialytic Hypotension: Mechanisms and Outcome

Benedict Sars, Frank M. van der Sande, Jeroen P. Kooman*

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

27 Citations (Web of Science)

Abstract

Intradialytic hypotension (IDH) occurs in approximately 1012% of treatments. Whereas several definitions for IDH are available, a nadir systolic blood pressure carries the strongest relation with outcome. Whereas the relation between IDH may partly be based on patient characteristics, it is likely that also impaired organ perfusion leading to permanent damage, plays a role in this relationship. The pathogenesis of IDH is multifactorial and is based on a combination of a decline in blood volume (BV) and impaired vascular resistance at a background of a reduced cardiovascular reserve. Measurements of absolute BV based on an on-line dilution method appear more promising than relative BV measurements in the prediction of IDH. Also, feedback treatments in which ultrafiltration rate is automatically adjusted based on changes in relative BV have not yet resulted in improvement. Frequent assessment of dry weight, attempting to reduce interdialytic weight gain and prescribing more frequent or longer dialysis treatments may aid in preventing IDH. The impaired vascular response can be improved using isothermic or cool dialysis treatment which has also been associated with a reduction in end organ damage, although their effect on mortality has not yet been assessed. For the future, identification of vulnerable patients based on artificial intelligence and on-line assessment of markers of organ perfusion may aid in individualizing treatment prescription, which will always remain dependent on the clinical context of the patient.

The Author(s). Published by S. Karger AG, Basel

Original languageEnglish
Pages (from-to)158-167
Number of pages10
JournalBlood Purification
Volume49
Issue number1-2
DOIs
Publication statusPublished - Mar 2020
EventRenal-Research-Institute 22nd International Conference on Dialysis, Advances in Chronic Kidney Disease (CKD) - Los Angeles, United States
Duration: 21 Jan 202024 Jan 2020

Keywords

  • BLOOD-PRESSURE
  • BODY-TEMPERATURE
  • CARDIOVASCULAR-RESPONSES
  • CORE TEMPERATURE
  • DIALYSATE TEMPERATURE
  • End-stage kidney disease
  • Exercise
  • FLUID STATUS
  • HEAT-STRESS
  • HEMODYNAMIC-RESPONSE
  • Hemodialysis
  • ISOLATED ULTRAFILTRATION
  • Physical activity
  • RANDOMIZED CONTROLLED-TRIAL
  • hypotension
  • Pathophysiology
  • Intradialytic
  • HEMODIALYSIS-PATIENTS
  • Dialysis

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